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NPI Code Detail

MEDICARE: DR. RICKY LEE GARRELS M.D.

MEDICARE: DR. RICKY LEE GARRELS 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
12083X0100XOccupational Medicine Physician036-089673IL
22083X0100XOccupational Medicine Physician29370IA
32083X0100XOccupational Medicine PhysicianBG3266322IA

General Provider Information

NPI Number : 1679535264
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICKY LEE GARRELS M.D.
Provider Business Mailing Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5310
Fax Number : 888-367-9650
Provider Business Practice Location Address
First Line : 4321 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-1269
Country : US
Telephone Number : 563-421-5310
Fax Number : 888-367-9650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 09/30/2021

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