Dr. Matthew Campbell Ericksen
Otolaryngology/Facial Plastic Surgery
1155 W Parkview St Suite 2j
Bolivar
, Missouri 65613-8279
Dr. Matthew Campbell Ericksen
Otolaryngology/Facial Plastic Surgery
1155 W Parkview St Suite 2j
Bolivar
, Missouri 65613-8279
(623) 734-6378
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Dr. Matthew Campbell Ericksen
- 1155 W Parkview St Suite 2j
- Bolivar, MO
- Zip : 65613-8279
- Phone : (623) 734-6378
Second Address
- Dr. Matthew Campbell Ericksen
- 1155 W Parkview St Suite 2j
- Bolivar, MO
- Zip : 65613-8279
- Phone : (417) 328-7000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2012015105 | MO |
National Provider Identifier
| NPI | 1285956797 |
|---|---|
| Provider Name | Dr. Matthew Campbell Ericksen |
| First Address | Bolivar, MO 65613-8279 |
| Second Address | Bolivar, MO 65613-8279 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/02/2010 |
| Last Update Date | 23/04/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.