Peter Erickson, M.D.

Primary specialty

Medical Toxicology (Preventive Medicine) PhysicianTaxonomy code 2083T0002X

License

E5746 Issued in TX

Practice address

120 Railroad St.
Boling, TX 77420

Phone

(979) 657-4000

Fax

(979) 657-3800

NPI assigned

Apr 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Longevity Medicine, PLLC

  • General Practice Physician
  • Boling, TX
  • NPI 1962672204
  NPD (past) Authorized official

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902020332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700",
            "city": "BOLING",
            "state": "TX",
            "postal_code": "774200700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RAILROAD ST.",
            "city": "BOLING",
            "state": "TX",
            "postal_code": "77420",
            "telephone_number": "979-657-4000",
            "fax_number": "979-657-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "PETER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083T0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Medical Toxicology",
            "state": "TX",
            "license": "E5746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Tedder Barnes, M.ED.,RPT
• Better Solutions LLC
• Boling Isd
• El Campo Memorial Hospital
• Larasha Renee Felder
• Longevity Medicine, PLLC
• Samantha Marie Tabares, FNP-C

• Medical Toxicology (Preventive Medicine) Physician in Boling, TX
• Providers in Boling, TX by specialty
• Medical Toxicology (Preventive Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.