Provider Demographics
NPI:1437264504
Name:CHANCE, RICKEY L (DO)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:L
Last Name:CHANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2154
Mailing Address - Country:US
Mailing Address - Phone:228-385-0075
Mailing Address - Fax:228-385-0073
Practice Address - Street 1:1759 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2132
Practice Address - Country:US
Practice Address - Phone:228-385-0075
Practice Address - Fax:228-385-0073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS11706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB64168Medicare UPIN