Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 46598 | UT |
NPI | 1124229521 |
---|---|
Provider Name | Jeffrey William Rickard |
First Address | Denver, CO 80256-0001 |
Second Address | Lafayette, CO 80026-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 11/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92584268 | (05) | CO |