Provider Demographics
NPI:1831162205
Name:ERICKSON, JON ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ALAN
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 1:3257 PROFESSIONAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2460
Mailing Address - Country:US
Mailing Address - Phone:530-823-6363
Mailing Address - Fax:530-823-6388
Practice Address - Street 1:3257 PROFESSIONAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2460
Practice Address - Country:US
Practice Address - Phone:530-823-6363
Practice Address - Fax:530-823-6388
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG568790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G568790Medicare PIN
CAA53201Medicare UPIN