Organization
ERICKSON SURGICAL CONSULTING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TY BOLTON ERICKSON M.D. (M.D)
(801) 727-2672
Entity
Organization
Contact information
Practice address
10011 CENTENNIAL PKWY, SUITE 150, SANDY, UT 84070-4156
(801) 727-2672
(801) 727-2682
Mailing address
63 E 11400 S, SUITE 252, SANDY, UT 84070-6705
(801) 727-2672
(801) 727-2682
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
63886701205
UT
Other
Enumeration date
08/10/2010
Last updated
10/05/2011
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