Individual
JEROLD CLANCY ERLANDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 4TH STREET, SIOUX CITY, IA 51101-1415
(712) 255-7746
(712) 255-0829
Mailing address
600 4TH STREET, SIOUX CITY, IA 51101-1415
(712) 255-7746
(712) 255-0829
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
38515
IA
207R00000X
Internal Medicine Physician
R-7904
IA
207RN0300X
Nephrology Physician
Primary
38515
IA
208M00000X
Hospitalist Physician
38515
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00606
—
IA
01
—
P01025432
RR MEDICARE
IA
Enumeration date
05/22/2007
Last updated
10/31/2014
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