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Individual
DR. TY BOLTON ERICKSON
Active
Individual
DR. TY BOLTON ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
6388670-1205
UT
207V00000X
Obstetrics & Gynecology Physician
Primary
M-6628
ID
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
6388670-1205
UT
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
M6628
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003678800
—
ID
Enumeration date
11/07/2006
Last updated
09/09/2014
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