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NPI Code Detail

MEDICARE: DR. JONATHAN MICHAEL RICKER DO

MEDICARE: DR. JONATHAN MICHAEL RICKER DO
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
1207R00000XInternal Medicine PhysicianDO1670NV
2207RG0100XGastroenterology PhysicianDO1670NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396843496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN MICHAEL RICKER DO
Provider Business Mailing Address
First Line : 2345 E PRATER WAY STE 207
Second Line :
City : SPARKS
State : NV
Zip : 89434-9634
Country : US
Telephone Number : 702-492-1162
Fax Number :
Provider Business Practice Location Address
First Line : 825 N GIBSON RD STE 201
Second Line :
City : HENDERSON
State : NV
Zip : 89011-1708
Country : US
Telephone Number : 702-492-1162
Fax Number : 702-492-1319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/28/2020

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