1508054172 NPI number — ERSKINE M CAPERTON M.D.

Table of content: ERSKINE M CAPERTON M.D. (NPI 1508054172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508054172 NPI number — ERSKINE M CAPERTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPERTON
Provider First Name:
ERSKINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508054172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 HAMLINE AVE N
Provider Second Line Business Mailing Address:
SUITE 508
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55113-5009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-633-6230
Provider Business Mailing Address Fax Number:
651-633-2428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2233 HAMLINE AVE N
Provider Second Line Business Practice Location Address:
SUITE 508
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55113-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-633-6230
Provider Business Practice Location Address Fax Number:
651-633-2428
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  18800 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24904 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 02369CA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 963940512001 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3201887 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 200 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111704 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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