Provider Demographics
NPI:1780683904
Name:ERICKSON, ROBERT C II (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:ERICKSON
Suffix:II
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 1:7442 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7022
Mailing Address - Country:US
Mailing Address - Phone:330-305-0838
Mailing Address - Fax:330-455-6114
Practice Address - Street 1:7442 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7022
Practice Address - Country:US
Practice Address - Phone:330-305-0838
Practice Address - Fax:330-455-6114
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044434207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0415287Medicaid
OH0415287Medicaid
OHER0471433Medicare ID - Type Unspecified