Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 24141 | TX |
NPI | 1457523839 |
---|---|
Provider Name | Helaman Paul Erickson |
First Address | Odessa, TX 79762-5354 |
Second Address | Odessa, TX 79765-8533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2008 |
Last Update Date | 02/07/2014 |