Provider Demographics
NPI:1982787412
Name:ERICKSON, DANIEL W (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:W
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:9710 BRIMHALL RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2779
Mailing Address - Country:US
Mailing Address - Phone:818-471-6268
Mailing Address - Fax:818-471-6268
Practice Address - Street 1:9710 BRIMHALL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2779
Practice Address - Country:US
Practice Address - Phone:818-471-6268
Practice Address - Fax:818-471-6268
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9426207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A94260Medicare PIN
CAI69483Medicare UPIN