Provider Demographics
NPI:1932283231
Name:ERICKSON, JAY ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROGER
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 1:1717 N E ST
Mailing Address - Street 2:SUITE 439
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-432-3692
Mailing Address - Fax:800-918-3765
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 439
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-432-3692
Practice Address - Fax:800-918-3765
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0067313207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377029000Medicaid
AL009505740Medicaid
26310ZMedicare PIN