| Doctor Name: | ERIK P SOUTHARD |
| NPI Number: | 1639325137 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D-NP |
| License Number: | 71001737A |
| Business Practice Address: | 114 N Division St Cayuga, IN - 479288230 |
| Business Phone Number: | 7654929042 |
| Business Fax Number: | 7654929048 |
| Mailing Address: | Po Box 344, CLINTON |
| State: | IN |
| Postal Code: | 478420344 |
| Phone Number: | 7654929042 |
| Fax Number: | 7654929048 |
| NPI Enumeration Date: | 08/15/2008 |
| NPI Last Update Date: | 07/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71001737A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |