Corey L Ericksen, DO is a
Family Medicine physician based in Fruit Heights, Utah. Corey L Ericksen is licensed to practice in Utah (license number 171802-1204) and his current practice location is 1762 Viewcourt, Fruit Heights, Utah. He can be reached at his office (for appointments etc.) via phone at
(801) 628-8877.
NPI number for Corey L Ericksen is 1912003922 and his current mailing address is 1762 View Ct, Fruit Heights, Utah. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1912003922.
Physician's Profile
| Full Name | Corey L Ericksen |
|---|
| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 1762 Viewcourt, Fruit Heights, Utah |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1912003922
- Provider Enumeration Date: 09/16/2006
- Last Update Date: 10/21/2019
Medical Identifiers
Medical identifiers for Corey L Ericksen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912003922 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 171802-1204 (Utah) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Corey L Ericksen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Corey L Ericksen, DO
1762 View Ct,
Fruit Heights, UT 84037-6704
Ph: (801) 628-8877 | Corey L Ericksen, DO
1762 Viewcourt,
Fruit Heights, UT 84037
Ph: (801) 628-8877 |
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