Erica M Deford, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085003126 Issued in IL

Practice address

2805 N Knoxville Ave
Peoria, IL 61604-2869

Phone

(309) 624-9400

Fax

(309) 624-2280

NPI assigned

Dec 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Erica M Plattner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254441600000",
    "number": "1306020334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-624-9400",
            "fax_number": "309-624-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-624-9400",
            "fax_number": "309-624-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFORD",
        "first_name": "ERICA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-27",
        "last_updated": "2009-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085003126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "809840",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "776530",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "37-1221637",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "PLATTNER",
            "middle_name": "M",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alan Debord, MD
• James R Debord, MD
• Anthony V Deceanne, DPM
• Arleta Dedianous, APRN
• Fizza Deen, MD
• Jason Deford, LCPC
• Lori A. Defreese, APN
• Joseph Degiovanni, PT
• Brian R Degise, DDS, PC
• Robert Joseph Degitz, PH.D., RN

• Medical Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.