Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 444 | MN |
N | 222Z00000X | Podiatrist | 444 | MN |
N | 213E00000X | Podiatrist | 759 | MO |
N | 222Z00000X | Podiatrist | 759 | MO |
N | 213EP1101X | Primary Podiatric Medicine | 444 | MN |
N | 2081S0010X | Sports Medicine | 444 | MN |
N | 213ES0000X | Sports Medicine | 444 | MN |
Y | 213ES0103X | Foot & Ankle Surgery | 444 | MN |
N | 213ES0103X | Foot & Ankle Surgery | 759 | MO |
NPI | 1003885617 |
---|---|
Provider Name | Dr. Loren Erickson |
First Address | Saint Paul, MN 55104-3898 |
Second Address | Saint Paul, MN 55104-3898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
564025300 | (05) | MN |
U08576 | (02) | MN |