Dr. Ty Bolton Erickson
Obstetrician & Gynecologist Female Pelvic Medicine and Reconstructive Surgeon
808 Pancheri Drive
Idaho Falls
, Idaho 83402-3344
Dr. Ty Bolton Erickson
Obstetrician & Gynecologist Female Pelvic Medicine and Reconstructive Surgeon
808 Pancheri Drive
Idaho Falls
, Idaho 83402-3344
(208) 552-4973
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About
Features
Specialties
- Obstetrician & Gynecologist
- Female Pelvic Medicine and Reconstructive Surgeon
Languages spoken
- English
Location
First Address
- Dr. Ty Bolton Erickson
- 2184 Channing Way Pmb #135
- Idaho Falls, ID
- Zip : 83404-8034
- Fax : (208) 552-4973
- Phone : (208) 552-6914
Second Address
- Dr. Ty Bolton Erickson
- 808 Pancheri Drive
- Idaho Falls, ID
- Zip : 83402-3344
- Fax : (208) 552-4973
- Phone : (208) 552-6900
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207V00000X | Obstetrician & Gynecologist | 6388670-1205 | UT |
| Y | 207V00000X | Obstetrician & Gynecologist | M-6628 | ID |
| N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 6388670-1205 | UT |
| N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | M6628 | ID |
National Provider Identifier
| NPI | 1083783823 |
|---|---|
| Provider Name | Dr. Ty Bolton Erickson |
| First Address | Idaho Falls, ID 83404-8034 |
| Second Address | Idaho Falls, ID 83402-3344 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/11/2006 |
| Last Update Date | 09/09/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 003678800 | (05) | ID |
| E87828 | (02) | |
| E87828 | (02) | ID |
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.