Provider Demographics
NPI:1144551326
Name:ERICKSON, ANDREW JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10966
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-2966
Mailing Address - Country:US
Mailing Address - Phone:202-427-2552
Mailing Address - Fax:
Practice Address - Street 1:1375 VISTA LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4643
Practice Address - Country:US
Practice Address - Phone:775-882-2067
Practice Address - Fax:775-882-3706
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013117208600000X
NV21747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery