Provider Demographics
NPI:1467031963
Name:RITCHEY, JACKSON STERLING (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:STERLING
Last Name:RITCHEY
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 1:2901 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4329
Mailing Address - Country:US
Mailing Address - Phone:414-649-3323
Mailing Address - Fax:
Practice Address - Street 1:2901 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4329
Practice Address - Country:US
Practice Address - Phone:414-649-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program