TY BOLTON ERICKSON

IDAHO FALLS, ID
NPI1083783823
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207V00000X Obstetrics & Gynecology
(Licence: ID  M-6628)
Additional Taxonomies207V00000X Obstetrics & Gynecology
(Licence: UT  6388670-1205)
207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery
(Licence: ID  M6628)
207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery
(Licence: UT  6388670-1205)
Enumeration Date2006-11-07
Last Update Date2014-09-09
Business Address
Dr. TY BOLTON ERICKSON MD
808 PANCHERI DRIVE
IDAHO FALLS, ID 83402-3344
Phone number: 208-552-6900
Mailing Address
Dr. TY BOLTON ERICKSON MD
2184 CHANNING WAY PMB #135
IDAHO FALLS, ID 83404-8034
Phone number: 208-552-6914