MEDICARE: DONATO R RICCI 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	207RG0100X	Gastroenterology Physician	ME 53429	FL

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	:	1417957432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONATO R RICCI MD

Provider Business Mailing Address
First Line	:	4800 BELFORT ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256
Country	:	US
Telephone Number	:	904-398-3262
Fax Number	:	904-265-4807

Provider Business Practice Location Address
First Line	:	3635 S CLYDE MORRIS BLVD
Second Line	:	SUITE 100
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-2300
Country	:	US
Telephone Number	:	386-788-1242
Fax Number	:	386-756-8802

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	05/25/2011

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Directions to “ DONATO R RICCI MD” Practice Location

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