Healthcare Provider Details

I. General information

NPI: 1720584519
Provider Name (Legal Business Name): JEFFREY ALAN RICKERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 207830
DALLAS TX
75320-7830
US

IV. Provider business mailing address

PO BOX 207830
DALLAS TX
75320-7830
US

V. Phone/Fax

Practice location:
  • Phone: 888-412-2649
  • Fax: 405-792-8910
Mailing address:
  • Phone: 888-412-2649
  • Fax: 405-792-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT018372
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: