Individual
MR. TIMOTHY D ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
PRESBYTERIAN RUST MEDICAL CENTER, 2400 UNSER BLVD SE STE 19100, RIO RANCHO, NM 87124-4740
(505) 823-8777
(505) 253-6580
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 823-8777
(505) 253-6580
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2006-0017
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2006-0017
MEDICAL LICENSE
NM
Enumeration date
08/17/2006
Last updated
06/18/2024
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