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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083783823 NPPES
Idaho MEDICAID 003678800

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