Provider Demographics
NPI:1114098894
Name:RICCI, LOUIS PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PATRICK
Last Name:RICCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16476 EDGEMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT MEYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6218
Mailing Address - Country:US
Mailing Address - Phone:239-437-4081
Mailing Address - Fax:239-437-3732
Practice Address - Street 1:16476 EDGEMONT DRIVE
Practice Address - Street 2:
Practice Address - City:FORT MEYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6218
Practice Address - Country:US
Practice Address - Phone:239-437-4081
Practice Address - Fax:239-437-3732
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLS3412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR7664596OtherDEA
E61183Medicare UPIN