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General NPI Number Information
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NPI Number | 1437103736
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Entity Type | Individual
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Provider Name | SAMUEL JAMES RICKERL MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 121 6TH AVE
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City | DE WITT
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State | IA
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Zip | 52742-2041
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Country | US
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Telephone | 563-357-6980
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Fax | 563-202-5307
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Provider Business Mailing Address
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Address Line | 121 6TH AVE
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City | DE WITT
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State | IA
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Zip | 52742-2041
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Country | US
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Telephone | 563-357-6980
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Fax | 563-202-5307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD-31160
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036102988
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License Number State | IL
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