| Doctor Name: | DR. JED H ERICKSON |
| NPI Number: | 1114207917 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 00385 |
| Business Practice Address: | 1818 S 10th Ave Suite 250 Caldwell, ID - 836054803 |
| Business Phone Number: | 2088558588 |
| Business Fax Number: | 2084598628 |
| Mailing Address: | 1818 S 10th Ave, Suite 250 CALDWELL |
| State: | ID |
| Postal Code: | 836054803 |
| Phone Number: | 2088558588 |
| Fax Number: | 2084598628 |
| NPI Enumeration Date: | 08/24/2011 |
| NPI Last Update Date: | 07/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 00385 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |