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General NPI Number Information
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NPI Number | 1720584519
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Entity Type | Individual
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Provider Name | JEFFREY ALAN RICKERT DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | PO BOX 207830
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City | DALLAS
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State | TX
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Zip | 75320-7830
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Country | US
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Telephone | 888-412-2649
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Fax | 405-792-8910
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Provider Business Mailing Address
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Address Line | PO BOX 207830
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City | DALLAS
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State | TX
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Zip | 75320-7830
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Country | US
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Telephone | 888-412-2649
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Fax | 405-792-8910
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OT018372
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 5145
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License Number State | TN
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