Individual
MICHAEL SHANE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 16TH AVE STE 100, SEATTLE, WA 98122
(206) 320-2484
(206) 320-4568
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00042707
WA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD00042707
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006928
—
WA
05
—
1295703221
—
WA
05
—
8360471
—
WA
Enumeration date
03/08/2006
Last updated
02/01/2022
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