Individual
DR. JEFFREY M RICKETTS
Active
Individual
DR. JEFFREY M RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101008399
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050054284
RAILROAD MEDICARE
MI
01
—
050D110480
BCBS GROUP BILL PIN
MI
05
—
3318293
—
MI
01
—
5410038
BCBS PIN
MI
01
—
CE1952
RAILROAD GROUP NUMBER
MI
01
—
JR008399
BCBS LICENSE NUMBER
MI
Enumeration date
04/10/2006
Last updated
07/03/2014
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