Provider Demographics
NPI:1316163405
Name:ERICKSON, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3701 WAKE FOREST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6832
Mailing Address - Country:US
Mailing Address - Phone:919-872-3171
Mailing Address - Fax:919-872-6739
Practice Address - Street 1:3701 WAKE FOREST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6832
Practice Address - Country:US
Practice Address - Phone:919-872-3171
Practice Address - Fax:919-872-6739
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD44236207XS0106X
MI4301083852390200000X
NC2010-00468207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program