Provider Demographics
NPI:1619136561
Name:RICKS, GEORGE T (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:RICKS
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 1:4310 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3829
Mailing Address - Country:US
Mailing Address - Phone:951-781-6335
Mailing Address - Fax:951-208-7244
Practice Address - Street 1:4310 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3829
Practice Address - Country:US
Practice Address - Phone:951-781-6335
Practice Address - Fax:951-208-7244
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26203Medicare UPIN