Provider Demographics
NPI:1093995623
Name:RICKERT, PAUL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
Last Name:RICKERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHASE CORPORATE DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1026
Mailing Address - Country:US
Mailing Address - Phone:205-733-6033
Mailing Address - Fax:205-733-6036
Practice Address - Street 1:1 CHASE CORPORATE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1026
Practice Address - Country:US
Practice Address - Phone:205-733-6033
Practice Address - Fax:205-733-6036
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2014-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL27964208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093995623Medicaid
AL1093995623Medicaid