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NPI Code Detail

MEDICARE: JEFFREY ALAN RICKERT DO

MEDICARE: JEFFREY ALAN RICKERT 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
1207RP1001XPulmonary Disease Physician5145TN
2207R00000XInternal Medicine PhysicianOT018372PA

General Provider Information

NPI Number : 1720584519
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY ALAN RICKERT DO
Provider Business Mailing Address
First Line : PO BOX 207830
Second Line :
City : DALLAS
State : TX
Zip : 75320-7830
Country : US
Telephone Number : 888-412-2649
Fax Number : 405-792-8910
Provider Business Practice Location Address
First Line : 6473 KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-4832
Country : US
Telephone Number : 865-588-8831
Fax Number : 865-588-8841
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 05/12/2026

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Directions to “ JEFFREY ALAN RICKERT DO” Practice Location

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