Individual
DR. JAY S ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 BAKER AVE, GLACIER MEDICAL ASSOCIATES, WHITEFISH, MT 59937-2901
(406) 862-2515
(406) 862-4229
Mailing address
1111 BAKER AVE, GLACIER MEDICAL ASSOCIATES, WHITEFISH, MT 59937-2901
(406) 862-2515
(406) 862-4229
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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