Provider Demographics
NPI:1821029307
Name:ERICKSON, JUDITH G (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:G
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14860 MONTFORT DR
Mailing Address - Street 2:SUITE 115, LB 32
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6873
Mailing Address - Country:US
Mailing Address - Phone:214-550-1469
Mailing Address - Fax:214-446-6010
Practice Address - Street 1:14860 MONTFORT DR
Practice Address - Street 2:SUITE 115, LB 32
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6873
Practice Address - Country:US
Practice Address - Phone:469-431-5656
Practice Address - Fax:877-658-8663
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-05-25
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Provider Licenses
StateLicense IDTaxonomies
TXL2875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0287Medicare ID - Type Unspecified
TXH74504Medicare UPIN