Provider Demographics
NPI:1245237627
Name:ERICKSON, RICHARD CARLTON (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARLTON
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-2801
Mailing Address - Country:US
Mailing Address - Phone:979-548-1850
Mailing Address - Fax:979-548-1836
Practice Address - Street 1:303 N MCKINNEY ST STE G
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-2808
Practice Address - Country:US
Practice Address - Phone:979-548-1850
Practice Address - Fax:979-548-1836
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX871238OtherMEDICARE ID- TYPE UNSPECIFIED
TX126473109Medicaid
TX126473102Medicaid