Provider Demographics
NPI:1336348499
Name:GLAS, ERIKA DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:DAWN
Last Name:GLAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:DAWN
Other - Last Name:FRYKBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8338
Practice Address - Country:US
Practice Address - Phone:904-398-9499
Practice Address - Fax:904-398-0118
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-049254207V00000X
FLOS11862207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006432800Medicaid
FLGM911ZMedicare PIN