Provider Demographics
NPI:1164794418
Name:OVERBEEK WAGER, ERIKA ALYSE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:ALYSE
Last Name:OVERBEEK WAGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:ALYSE
Other - Last Name:WAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:IRON HORSE FAMILY MEDICINE CLINIC
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-524-4150
Mailing Address - Fax:719-524-2258
Practice Address - Street 1:320 E FONTANERO ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7535
Practice Address - Country:US
Practice Address - Phone:719-365-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1063208D00000X
CODR.0060136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO028918OtherKAISER COMMERCIAL NUMBER