Provider Demographics
NPI:1558571497
Name:ERLANDSON, JEROLD CLANCY (MD)
Entity Type:Individual
Prefix:
First Name:JEROLD
Middle Name:CLANCY
Last Name:ERLANDSON
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 1:600 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1415
Mailing Address - Country:US
Mailing Address - Phone:712-255-7746
Mailing Address - Fax:712-255-0829
Practice Address - Street 1:600 4TH STREET
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1415
Practice Address - Country:US
Practice Address - Phone:712-255-7746
Practice Address - Fax:712-255-0829
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7904207R00000X
IA38515207R00000X, 207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00606Medicaid
IAP01025432OtherRR MEDICARE
IA219640017Medicare PIN