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General NPI Number Information
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NPI Number | 1306020979
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Entity Type | Organization
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Legal Business Name | LEE W RICKETTS II MD PLLC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 1782 BRYAN STATION ROAD
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City | LEXINGTON
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State | KY
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Zip | 40505
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Country | US
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Telephone | 859-294-0077
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Fax | 859-294-0078
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Provider Business Mailing Address
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Address Line | 1782 BRYAN STATION ROAD
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City | LEXINGTON
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State | KY
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Zip | 40505
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Country | US
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Telephone | 859-294-0077
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Fax | 859-294-0078
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | MR. LEE W RICKETTS II
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Credential | MD
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Telephone | 859-294-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 30881
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30881
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License Number State | KY
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