Provider Demographics
NPI:1366518060
Name:DALLAS, ERIKA D (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:D
Last Name:DALLAS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4645 VILLAGE SQUARE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5252
Mailing Address - Country:US
Mailing Address - Phone:270-444-9934
Mailing Address - Fax:270-444-9937
Practice Address - Street 1:4645 VILLAGE SQUARE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5252
Practice Address - Country:US
Practice Address - Phone:270-444-9934
Practice Address - Fax:270-444-9937
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY35228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH14625Medicare UPIN