Healthcare Provider Details

I. General information

NPI: 1043281975
Provider Name (Legal Business Name): RICKY G DEERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 GEORGE WALLCE DR W
RAINSVILLE AL
35986
US

IV. Provider business mailing address

PO BOX 1188
RAINSVILLE AL
35986-1188
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-1181
  • Fax: 256-638-1183
Mailing address:
  • Phone: 256-638-1181
  • Fax: 256-638-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12797
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: