Provider Demographics
NPI:1487634051
Name:ERICKSON, JON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:ERICKSON
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 1:333 W. HAMPDEN AVE.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2336
Mailing Address - Country:US
Mailing Address - Phone:303-761-5646
Mailing Address - Fax:303-761-9280
Practice Address - Street 1:333 W. HAMPDEN AVE.
Practice Address - Street 2:SUITE 600
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2336
Practice Address - Country:US
Practice Address - Phone:303-761-5646
Practice Address - Fax:303-761-9280
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29722207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01297225Medicaid
COD43114Medicare UPIN
COC475438Medicare PIN