Provider Demographics
NPI:1457882391
Name:ERICKSEN, CONNOR JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:JAMES
Last Name:ERICKSEN
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 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6262
Mailing Address - Fax:
Practice Address - Street 1:6200 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7755
Practice Address - Country:US
Practice Address - Phone:641-754-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-48462207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist