Provider Demographics
NPI:1356453013
Name:CARRIZO, RICARDO J (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:CARRIZO
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 1:5012 US HWY 75 S STE 300
Mailing Address - Street 2:ATTN. IPM BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:806-351-7200
Mailing Address - Fax:
Practice Address - Street 1:1411 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5555
Practice Address - Country:US
Practice Address - Phone:806-354-1015
Practice Address - Fax:806-351-7274
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0427874 03Medicaid
TX042787402Medicaid
TX8EK956OtherBCBS
TX8R5450OtherBCBS
TXP01407122OtherRR MEDICARE
TX262964ZHHLMedicare PIN
TX8EK956OtherBCBS