Provider Demographics
NPI:1043281975
Name:DEERMAN, RICKY G (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:G
Last Name:DEERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1188
Mailing Address - Country:US
Mailing Address - Phone:256-638-1181
Mailing Address - Fax:256-638-1183
Practice Address - Street 1:83 GEORGE WALLCE DR W
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-1181
Practice Address - Fax:256-638-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000018209Medicaid
AL080013703OtherMEDICARE B RAILROAD
AL51018209OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL000018209Medicaid
000018209Medicare PIN