| Doctor Name: | DR. TY BOLTON ERICKSON |
| NPI Number: | 1083783823 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 6388670-1205 |
| Business Practice Address: | 808 Pancheri Drive Idaho Falls, ID - 834023344 |
| Business Phone Number: | 2085526900 |
| Business Fax Number: | 2085524973 |
| Mailing Address: | 2184 Channing Way Pmb #135, IDAHO FALLS |
| State: | ID |
| Postal Code: | 834048034 |
| Phone Number: | 2085526914 |
| Fax Number: | 2085524973 |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 09/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 6388670-1205 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | UT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |