MEDICARE: MARI A RICKER 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
1	202D00000X	Integrative Medicine Physician	MD25245	AZ
2	207Q00000X	Family Medicine Physician	MD25245	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00604911	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	49518	OTHER	AZ	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477500049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI A RICKER MD

Provider Business Mailing Address
First Line	:	PO BOX 245052
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5052
Country	:	US
Telephone Number	:	520-626-5914
Fax Number	:	520-626-1640

Provider Business Practice Location Address
First Line	:	707 N ALVERNON WAY
Second Line	:	SUITE 101
City	:	TUCSON
State	:	AZ
Zip	:	85711-1827
Country	:	US
Telephone Number	:	520-694-8888
Fax Number	:	520-694-1640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	01/22/2025

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Directions to “ MARI A RICKER MD” Practice Location

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