Provider Demographics
NPI:1336589662
Name:ERICKSON, JOHN G (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1415 WOODLAND AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3203
Mailing Address - Country:US
Mailing Address - Phone:515-241-8595
Mailing Address - Fax:515-241-4080
Practice Address - Street 1:1415 WOODLAND AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3203
Practice Address - Country:US
Practice Address - Phone:515-241-8595
Practice Address - Fax:515-241-4080
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA000872213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery