Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 26452 | NE |
Y | 207X00000X | Orthopaedic Surgeon | 62746 | MN |
N | 207X00000X | Orthopaedic Surgeon | A84928 | CA |
NPI | 1023009370 |
---|---|
Provider Name | Dr. Gregory A Erickson |
First Address | Red Wing, MN 55066-2848 |
Second Address | Red Wing, MN 55066-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES0000 | (02) | CA |