Provider Demographics
NPI:1134506256
Name:ERICKSON, CATHRYN (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
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:PO BOX 14001
Mailing Address - Street 2:PMB 361
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340
Mailing Address - Country:US
Mailing Address - Phone:082-911-9852
Mailing Address - Fax:082-039-4902
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-291-1985
Practice Address - Fax:208-203-9490
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
IDO-1252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program