Provider Demographics
NPI:1710171145
Name:JON M. ERICKSON, MD, P.C.
Entity Type:Organization
Organization Name:JON M. ERICKSON, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-926-8734
Mailing Address - Street 1:500 DISCOVERY PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8639
Mailing Address - Country:US
Mailing Address - Phone:303-926-8734
Mailing Address - Fax:
Practice Address - Street 1:500 DISCOVERY PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8639
Practice Address - Country:US
Practice Address - Phone:303-926-8734
Practice Address - Fax:303-926-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33524207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty