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General NPI Number Information
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NPI Number | 1235673633
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Entity Type | Organization
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Legal Business Name | A.VICKI RICKERSON MD
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 8601 VILLAGE DR STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5509
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Country | US
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Telephone | 210-646-7227
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Fax | 210-654-3575
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Provider Business Mailing Address
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Address Line | 8601 VILLAGE DR STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5509
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Country | US
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Telephone | 210-646-7227
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Fax | 210-654-3575
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Authorized Official
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Title or Position | OWNER
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Name | AVERESS VICKI RICKERSON
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Credential | M.D.
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Telephone | 210-646-7227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AP132396
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License Number State | TX
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