Basic Information
| Provider Information | |||||||||
| NPI: | 1558571497 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERLANDSON | ||||||||
| FirstName: | JEROLD | ||||||||
| MiddleName: | CLANCY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122557746 | ||||||||
| FaxNumber: | 7122550829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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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 | 207R00000X | R-7904 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 38515 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 38515 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 38515 | IA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 00606 | 05 | IA | MEDICAID | P01025432 | 01 | IA | RR MEDICARE | OTHER |