Provider Demographics
NPI:1568441707
Name:EDUARDO L RICAURTE MD
Entity Type:Organization
Organization Name:EDUARDO L RICAURTE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICAURTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-355-9996
Mailing Address - Street 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1644
Mailing Address - Country:US
Mailing Address - Phone:563-355-9996
Mailing Address - Fax:563-355-9997
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1644
Practice Address - Country:US
Practice Address - Phone:563-355-9996
Practice Address - Fax:563-355-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104554Medicaid
IAI13391Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
IA1104554Medicaid