Provider Demographics
NPI:1215998901
Name:ERICKSON, STEVEN MAYNARD (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MAYNARD
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N. 10TH STREET, SUITE B
Mailing Address - Street 2:BANNER CONCUSSION CENTER
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-839-7285
Mailing Address - Fax:602-839-7272
Practice Address - Street 1:1320 N. 10TH STREET, SUITE B
Practice Address - Street 2:BANNER CONCUSSION CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-839-7285
Practice Address - Fax:602-839-7272
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23040207R00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine