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NPI Code Detail

MEDICARE: DR. GEORGE T. RICKS M.D

MEDICARE: DR. GEORGE T. RICKS M.D
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
1207Q00000XFamily Medicine PhysicianA30710CA

General Provider Information

NPI Number : 1619136561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE T. RICKS M.D
Provider Business Mailing Address
First Line : 4310 ORANGE ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-3829
Country : US
Telephone Number : 951-781-6335
Fax Number : 951-208-7244
Provider Business Practice Location Address
First Line : 4310 ORANGE ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-3829
Country : US
Telephone Number : 951-781-6335
Fax Number : 951-208-7244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 07/09/2012

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Directions to “ DR. GEORGE T. RICKS M.D” Practice Location

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