Individual
MR. RICARDO MEDINA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1522
Mailing address
530 N PEARL AVE, JOPLIN, MO 64801-2465
(417) 437-7027
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S202187064
DRIVERS LICENSE
TX
Enumeration date
09/11/2016
Last updated
09/14/2016
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