Provider Demographics
NPI:1285956797
Name:ERICKSEN, MATTHEW CAMPBELL (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CAMPBELL
Last Name:ERICKSEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1801 SE HILLMOOR DR STE B-105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-398-9911
Mailing Address - Fax:
Practice Address - Street 1:1155 W PARKVIEW ST
Practice Address - Street 2:SUITE 2J
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-8279
Practice Address - Country:US
Practice Address - Phone:417-328-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012015105207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery