IndividualActive
Matthew Ericksen, D.O.
NPI 1285956797 · Otolaryngology/Facial Plastic Surgery Physician · Bolivar, MO
Provider details
- NPI number
- 1285956797
- Entity type
- Individual
- Primary specialty
- Otolaryngology/Facial Plastic Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- License
- 2012015105 (MO)
Practice location
1155 W Parkview St
Suite 2j
Bolivar, MO 65613-8279
Phone: (417) 328-7000
Mailing address
1801 Se Hillmoor Dr Ste B-105
Port St Lucie, FL 34952-7545
Registry dates
- Enumerated
- 2010-02-25
- Last updated
- 2024-12-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.