Provider Demographics
NPI:1114207917
Name:ERICKSON, JED H (DPM)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:H
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 S 10TH AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4803
Mailing Address - Country:US
Mailing Address - Phone:208-855-8588
Mailing Address - Fax:208-459-8628
Practice Address - Street 1:1818 S 10TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4803
Practice Address - Country:US
Practice Address - Phone:208-855-8588
Practice Address - Fax:208-459-8628
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP229213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery