Provider Demographics
NPI:1649729781
Name:DEARDORF, ERIKA GEHL (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:GEHL
Last Name:DEARDORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S INTERSTATE 35 STE N5
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6921
Mailing Address - Country:US
Mailing Address - Phone:512-729-3138
Mailing Address - Fax:512-599-9181
Practice Address - Street 1:2000 S INTERSTATE 35 STE N5
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6921
Practice Address - Country:US
Practice Address - Phone:512-729-3138
Practice Address - Fax:512-599-9181
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10968363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical