Provider Demographics
NPI:1891958104
Name:ERICKSEN, RYAN T (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:ERICKSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:940 NE 13TH ST
Mailing Address - Street 2:STE 2G-2300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5008
Mailing Address - Country:US
Mailing Address - Phone:405-271-2429
Mailing Address - Fax:405-271-2421
Practice Address - Street 1:940 NE 13TH ST
Practice Address - Street 2:STE 2G-2300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5008
Practice Address - Country:US
Practice Address - Phone:405-271-2429
Practice Address - Fax:405-271-2421
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5072208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine