Provider Demographics
NPI:1457516296
Name:ERIKSEN, ERICH GERALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:GERALD
Last Name:ERIKSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2902
Mailing Address - Country:US
Mailing Address - Phone:660-646-5522
Mailing Address - Fax:
Practice Address - Street 1:2799 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2902
Practice Address - Country:US
Practice Address - Phone:660-646-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000808213ES0103X
MO2008033461213ES0103X
KS12-00385213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery