Provider Demographics
NPI:1346933512
Name:GAMMON, ERIK DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:DOUGLAS
Last Name:GAMMON
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 1:1705 S SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5633
Mailing Address - Country:US
Mailing Address - Phone:989-835-4041
Mailing Address - Fax:989-835-8121
Practice Address - Street 1:1705 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5633
Practice Address - Country:US
Practice Address - Phone:989-835-4041
Practice Address - Fax:989-835-8121
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI4351051020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine