Individual
BRANDON BEAU RICKERTSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
918 W PLATT ST # 1, MAQUOKETA, IA 52060-2038
(563) 652-5145
(563) 652-3674
Mailing address
918 W PLATT ST # 1, MAQUOKETA, IA 52060-2038
(563) 652-5145
(563) 652-3674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R-9693
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO-04590
IA LICENSE NUMBER
IA
Enumeration date
06/25/2013
Last updated
05/19/2021
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