Individual
EDWARD A RICKETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 NW 11TH ST, SUITE109, HERMISTON, OR 97838-8602
(541) 567-5075
Mailing address
600 NW 11TH ST, SUITE109, HERMISTON, OR 97838-8602
(541) 567-5075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD18739
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060595
—
OR
Enumeration date
02/12/2007
Last updated
09/28/2007
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