Individual
GARY DUANE ERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 SW 13TH AVE, PORTLAND, OR 97205
(503) 221-0161
(503) 221-4451
Mailing address
1605 GEORGE JACKSON RD, MAUPIN, OR 97037-9208
(541) 395-2911
(541) 395-2912
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD20450
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269835
—
OR
Enumeration date
09/28/2006
Last updated
12/23/2011
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