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NPI Code Detail

MEDICARE: JANE H. RICKS MD

MEDICARE:   JANE H. RICKS  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician184829-1205UT

General Provider Information

NPI Number : 1295745651
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE H. RICKS MD
Provider Business Mailing Address
First Line : PO BOX 1557
Second Line :
City : DRAPER
State : UT
Zip : 84020-1557
Country : US
Telephone Number : 801-891-4875
Fax Number :
Provider Business Practice Location Address
First Line : 1440 SUNNYSIDE AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-1631
Country : US
Telephone Number : 801-891-4875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/08/2007

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