MEDICARE: DR. GARY L. ERICKSON D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	801	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841290012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L. ERICKSON D.P.M.

Provider Business Mailing Address
First Line	:	921 RYANFIELD CT
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-8109
Country	:	US
Telephone Number	:	817-926-5287
Fax Number	:	817-926-5288

Provider Business Practice Location Address
First Line	:	910 W NORTHSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-9046
Country	:	US
Telephone Number	:	817-926-5287
Fax Number	:	817-926-5288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/18/2025

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