Provider Demographics
NPI:1073555371
Name:RICO, ALEXANDER GLEN (M,D)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GLEN
Last Name:RICO
Suffix:
Gender:M
Credentials:M,D
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9399 RIDGETOP BLVD NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-337-2015
Mailing Address - Fax:360-516-6324
Practice Address - Street 1:9399 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE A
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-337-2015
Practice Address - Fax:360-516-6324
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180006663OtherRAILROAD MEDICARE
5728034OtherAETNA
WA8113573Medicaid
RI6599OtherREGENCE BLUESHIELD
WA75446OtherLABOR & INDUSTRIES
WA8931224OtherCRIME VICTIMS COMP
WA8931224OtherCRIME VICTIMS COMP
AR2203242OtherDEA
5728034OtherAETNA
WAGAB05201Medicare PIN
WAG000250432Medicare PIN
WA8113573Medicaid
WAG000250508Medicare PIN
180006663OtherRAILROAD MEDICARE