Erickson, Ty Bolton
Erickson, Ty Bolton is an individual health care provider with primary practice located at 808 Pancheri Drive , Idaho Falls ID 83402-3344. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Erickson, Ty Bolton can be contacted via phone (208) 552-6900.Contact Information
Primary practice address
808 Pancheri Drive
Idaho Falls ID 83402-3344
Phone: (208) 552-6900
Fax: (208) 552-4973
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | M-6628 | Idaho |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 6388670-1205 | Utah |
| Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery | 207VF0040X | M6628 | Idaho |
| Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery | 207VF0040X | 6388670-1205 | Utah |
Profile Details
| NPI number | 1083783823 |
|---|---|
| LBN Legal business name | Erickson, Ty Bolton |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 7th, 2006 |
| Last updated | Sep 9th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083783823 | NPPES |
| Idaho | MEDICAID | 003678800 |
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