Ricks, Deron J
Ricks, Deron J is an individual health care provider with primary practice located at 3100 Channing Way Ste 115, Idaho Falls ID 83404-1647. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Ricks, Deron J can be contacted via phone (208) 535-4130.Contact Information
Primary practice address
3100 Channing Way Ste 115
Idaho Falls ID 83404-1647
Phone: (208) 535-4130
Fax: (208) 535-4125
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA216 | Idaho |
Profile Details
| NPI number | 1639156573 |
|---|---|
| LBN Legal business name | Ricks, Deron J |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 30th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639156573 | NPPES |
| Idaho | Other | PA555 | BLUE CROSS |
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