Individual
DR. STEPHANIE A RICCALARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2570 NW EDENBOWER BLVD., SUITE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD., SUITE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5415
NE
207Q00000X
Family Medicine Physician
Primary
MD126056
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0577260001
GROUP DMERC
OR
01
—
1407812365
GROUP NPI
OR
01
—
161133
GROUP DMAP - OREGON MEDICAID
OR
05
—
500612601
—
OR
01
—
R0000WFBTV
GROUP MEDICARE NUMBER
OR
Enumeration date
04/13/2007
Last updated
08/29/2019
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