Provider Demographics
NPI:1396855458
Name:CHILDERS, RICKY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:L
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 S FM 51 STE 103
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3644
Mailing Address - Country:US
Mailing Address - Phone:940-627-6976
Mailing Address - Fax:940-627-3491
Practice Address - Street 1:1713 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3642
Practice Address - Country:US
Practice Address - Phone:940-627-6976
Practice Address - Fax:940-627-3491
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1932213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334278401Medicaid
TX8EE386OtherBCNSTX
TX328923YXEMMedicare PIN