Provider Demographics
NPI:1457354367
Name:ERICKSON, RICK EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:EARL
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 1:1001 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-7483
Mailing Address - Country:US
Mailing Address - Phone:903-785-5800
Mailing Address - Fax:903-785-5821
Practice Address - Street 1:1001 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-7483
Practice Address - Country:US
Practice Address - Phone:903-785-5800
Practice Address - Fax:903-785-5821
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7527207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5078753OtherAETNA ID#
TX0039GSOtherBCBS GROUP #
TX4193431OtherBLUELINK NUMBER
TX144949801Medicaid
OK100147420AMedicaid
TX046456202Medicaid
OK100755410AMedicaid
TX8B5440OtherBCBS PROVIDER #
OK100755410AMedicaid
G93431Medicare UPIN
TX8B5440OtherBCBS PROVIDER #