Provider Demographics
NPI:1538470489
Name:ERNEST, ERIC VICKERY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:VICKERY
Last Name:ERNEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1577 GREENBRIER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1048
Mailing Address - Country:US
Mailing Address - Phone:402-201-6138
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:651-254-5216
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2013-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN56310207P00000X
WI60301-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine