Provider Demographics
NPI:1134188337
Name:ERICKSON, LAWRENCE G (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:ERICKSON
Suffix:
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 1:1175 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1056
Mailing Address - Country:US
Mailing Address - Phone:657-480-4100
Mailing Address - Fax:651-480-6801
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:657-480-4100
Practice Address - Fax:651-480-6801
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21433207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8D641EROtherBLUE CROSS
MN984810186002OtherPREFERRED ONE
MNHP16163OtherHEALTHPARTNERS
MN39-42042OtherMEDICA
MN080180767OtherRAILROAD MEDICARE
MN785783700Medicaid
MN080180767OtherRAILROAD MEDICARE
MN080001421Medicare ID - Type Unspecified