Organization
CARL F. ERICKSON, MD PA
Active
Other names
Pembroke Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL FREDERICK ERICKSON MD (OWNER PHYSICIAN)
(210) 641-6559
Entity
Organization
Contact information
Practice address
9711 HUEBNER, BLDG 2, SAN ANTONIO, TX 78240-3163
(210) 641-6559
(210) 699-9968
Mailing address
9711 HUEBNER, BLDG 2, SAN ANTONIO, TX 78240-3163
(210) 641-6559
(210) 699-9968
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H2361
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002HD
BC/BS GROUP
TX
05
—
102522303
—
TX
05
—
150274201
—
TX
01
—
5041089
AETNA
TX
01
—
8F3210
BC/BS INDIVIDUAL
TX
Enumeration date
08/29/2006
Last updated
04/09/2010
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