Basic Information
| Provider Information | |||||||||
| NPI: | 1992806939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERIATOR | ||||||||
| FirstName: | IKECHUKWUI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 N STATE STREET | ||||||||
| Address2: | STE. S108-A | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845900 | ||||||||
| FaxNumber: | 6019845939 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 N STATE STREET | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845900 | ||||||||
| FaxNumber: | 6019845939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 04/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 15724 | MS | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 15724 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00462198 | 01 | MS | RR MEDICARE | OTHER | 07639518 | 05 | MS | MEDICAID | P00064306 | 01 | MS | RAILROAD MEDICARE | OTHER |