Provider Demographics
NPI:1164477154
Name:ERICKSEN, ALAN STEVEN (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:STEVEN
Last Name:ERICKSEN
Suffix:
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN371242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509265OtherMEDICAID - MTI
TN3335347Medicaid
TN4114096OtherBCBS
TN4291466OtherBCBS - MTI
KY64122591OtherKY MEDICAID
TN1509265Medicaid
TN4200472OtherBCBS TN
TN3882323Medicaid
TN4200472OtherBCBS TN
TN3882323Medicaid
TN4114096OtherBCBS
TN1509265OtherMEDICAID - MTI
TN3335347Medicaid