Provider Demographics
NPI:1659338788
Name:JANSSON, ERIK J (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
Last Name:JANSSON
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 1:3798 JANES ROAD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4746
Mailing Address - Country:US
Mailing Address - Phone:707-822-7222
Mailing Address - Fax:707-822-1342
Practice Address - Street 1:3798 JANES ROAD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4746
Practice Address - Country:US
Practice Address - Phone:707-822-7222
Practice Address - Fax:707-822-1342
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC35343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C353430Medicaid
CA00C353430Medicare ID - Type Unspecified
CA00C353430Medicaid