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Individual
DR. JAY S ERICKSON
Active
Individual
DR. JAY S ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6585
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061
BLUE CROSS/BLUE SHIELD
MT
01
—
000008287
MEDICARE PART B GRP ID#
MT
05
—
0085163
—
MT
01
—
080026846
RAILROAD MEDICARE PIN#
MT
01
—
1104882232
GLACIER MEDICAL ASSOC NPI
MT
01
—
27D0411341
CLIA ID#--LAB CERT
MT
01
—
6585
MONTANA STATE LICENSE
MT
01
—
810350909
FEIN
MT
01
—
CI2709
RAILROAD MEDICARE GRP ID#
MT
Enumeration date
09/20/2006
Last updated
05/12/2008
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