Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | DO12690 | OR |
Y | 207Q00000X | Family Doctor | DO12690 | OR |
NPI | 1710970876 |
---|---|
Provider Name | Dr. Carl Michael Erickson |
First Address | Milwaukie, OR 97222-2245 |
Second Address | Milwaukie, OR 97222-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120000019 | MEDICARE RAILROAD (01) | OR |
226639 | (05) | OR |
D38480 | (02) | OR |