Individual
DR. JACK E RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD OBGYN
Contact information
Practice address
8333 N DAVIS HWY FL 7, PENSACOLA, FL 32514-6050
(850) 494-4600
(850) 969-2037
Mailing address
8333 N DAVIS HWY FL 7, PENSACOLA, FL 32514-6050
(850) 969-2038
(850) 969-2037
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME119487
FL
207V00000X
Obstetrics & Gynecology Physician
R5C65
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202688602
—
MO
Enumeration date
10/30/2006
Last updated
11/20/2020
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