Individual
DR. MARK D ERICKSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
802 MEDICAL DR, SUITE 400, LONGVIEW, TX 75605-5100
(903) 757-7871
(903) 753-2479
Mailing address
PO BOX 847176, DALLAS, TX 75284-7176
(903) 237-1800
(903) 237-1810
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
H2362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127746908
—
TX
01
—
P00417180
RR MEDICARE
TX
Enumeration date
03/03/2006
Last updated
05/18/2015
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