Provider Demographics
NPI:1104829027
Name:ERICKSON, CYRUS C III (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:C
Last Name:ERICKSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58326
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-8326
Mailing Address - Country:US
Mailing Address - Phone:615-771-3033
Mailing Address - Fax:615-771-0398
Practice Address - Street 1:1909 MALLORY LN STE 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2843
Practice Address - Country:US
Practice Address - Phone:615-771-3033
Practice Address - Fax:615-771-3029
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39029174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29194Medicare UPIN
TN103I728247Medicare PIN