Provider Demographics
NPI:1477655660
Name:BECKER, RICKY C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:C
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 INTERCHANGE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2079
Mailing Address - Country:US
Mailing Address - Phone:701-530-3333
Mailing Address - Fax:701-530-3009
Practice Address - Street 1:300 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4439
Practice Address - Country:US
Practice Address - Phone:701-323-6000
Practice Address - Fax:701-323-5918
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6735208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462620Medicaid
ND18022Medicaid
NDN712729Medicare PIN