Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 16622 | AL |
NPI | 1154388783 |
---|---|
Provider Name | Dr. Ricky L Ledkins |
First Address | Opelika, AL 36803-4283 |
Second Address | Opelika, AL 36801-5452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510-79264 | BLUE CROSS OF AL PROV # (01) | AL |
F35837 | (02) | AL |