Individual
WADE ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3066 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7299
(907) 357-9593
Mailing address
3066 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7299
(907) 357-9593
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
4593
AK
207Q00000X
Family Medicine Physician
Primary
4593
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD45932
—
AK
Enumeration date
06/03/2006
Last updated
10/11/2011
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