Provider Demographics
NPI:1164414702
Name:BARE, RICKY L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:L
Last Name:BARE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4500
Practice Address - Country:US
Practice Address - Phone:828-253-5314
Practice Address - Fax:828-254-5216
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34557208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13049OtherBCBS PROVIDER #
NC340015564OtherRR MEDICARE
NC8913049Medicaid
NC1165946OtherGATEWAY HEALTH
NC19-71240OtherUNITED HEALTH CARE
NC5013412OtherAETNA
NC8382104006OtherCIGNA
NCP00996850OtherRAILROAD MEDICARE
NC19-71240OtherUNITED HEALTH CARE
NC2164498DMedicare PIN
NC8382104006OtherCIGNA