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Individual
DR. DAVID LAMONT ERICSON
Active
Individual
DR. DAVID LAMONT ERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036117087
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820800
MEDICARE PTAN(GROUP)
IL
01
—
K36911
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
02/09/2007
Last updated
04/02/2021
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