Provider Demographics
NPI:1245246453
Name:RIEGER, ERIK HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:HERBERT
Last Name:RIEGER
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0469
Mailing Address - Country:US
Mailing Address - Phone:719-345-3115
Mailing Address - Fax:719-345-3331
Practice Address - Street 1:1335 PHAY AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2349
Practice Address - Country:US
Practice Address - Phone:719-345-3115
Practice Address - Fax:719-345-3331
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0047412208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100129970BMedicaid
KS100129970BMedicaid
KSF05717Medicare UPIN