MEDICARE: JOHN CLYDE RICKABAUGH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9400133	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396722534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CLYDE RICKABAUGH MD

Provider Business Mailing Address
First Line	:	3608 MEDICAL PARK CT
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4347
Country	:	US
Telephone Number	:	252-247-3476
Fax Number	:	252-247-3478

Provider Business Practice Location Address
First Line	:	3608 MEDICAL PARK CT
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4347
Country	:	US
Telephone Number	:	252-247-3476
Fax Number	:	252-247-3478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	06/20/2024

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