Provider Demographics
NPI:1336181361
Name:ERICKSON, FRANK A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
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 1:109 NE ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1635
Mailing Address - Country:US
Mailing Address - Phone:541-278-9554
Mailing Address - Fax:541-278-9549
Practice Address - Street 1:109 NE ELLIS AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1635
Practice Address - Country:US
Practice Address - Phone:541-278-9554
Practice Address - Fax:541-278-9549
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020027182085R0202X
KY398022085R0202X
ORMD179562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207369307Medicaid
MOP00228268Medicare ID - Type UnspecifiedRR
E86213Medicare UPIN
KY0995002Medicare ID - Type Unspecified
MO207369307Medicaid