Provider Demographics
NPI:1093796625
Name:ESPER, ERIK O (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:O
Last Name:ESPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4204
Mailing Address - Country:US
Mailing Address - Phone:814-833-8800
Mailing Address - Fax:814-833-2079
Practice Address - Street 1:2820 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4204
Practice Address - Country:US
Practice Address - Phone:814-833-8800
Practice Address - Fax:814-833-2079
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007881L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013008160001Medicaid
PA0013008160001Medicaid
F35853Medicare UPIN