Basic Information
| Provider Information | |||||||||
| NPI: | 1134188337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6574804100 | ||||||||
| FaxNumber: | 6514806801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 NININGER RD | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550331056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6574804100 | ||||||||
| FaxNumber: | 6514806801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 21433 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8D641ER | 01 | MN | BLUE CROSS | OTHER | 984810186002 | 01 | MN | PREFERRED ONE | OTHER | HP16163 | 01 | MN | HEALTHPARTNERS | OTHER | 39-42042 | 01 | MN | MEDICA | OTHER | 080180767 | 01 | MN | RAILROAD MEDICARE | OTHER | 785783700 | 05 | MN | MEDICAID |