Provider Demographics
NPI:1629064225
Name:ERICKSON, BRIAN ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLAN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:STE 5011
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-776-7600
Mailing Address - Fax:719-473-3553
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:STE 5011
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-776-7600
Practice Address - Fax:719-473-3553
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005026717208600000X
NMMD2014-0814207P00000X
CODR.0051687208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBF558ZMedicare PIN