Individual
M ERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N. MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3578
Mailing address
100 N. MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3578
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
363155-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0153221
—
MT
01
—
100504905
FIRST HEALTH
UT
05
—
120083600
—
WY
01
—
219176
ALTIUS
UT
01
—
36315512000001
BCBS
UT
01
—
693497
DESERET MUTUAL
UT
01
—
77988
HEALTHY U
UT
01
—
78899
PEHP
UT
05
—
806196700
—
ID
01
—
870280408MTY
EDUCATORS MUTUAL
UT
05
—
878407
—
AZ
01
—
PRA06245
MOLINA
UT
Enumeration date
06/27/2006
Last updated
10/28/2011
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