Provider Demographics
NPI:1689215386
Name:BOBBINS, RICO
Entity Type:Individual
Prefix:MR
First Name:RICO
Middle Name:
Last Name:BOBBINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NEW FORT BROWDER RD
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1027
Mailing Address - Country:US
Mailing Address - Phone:334-695-9799
Mailing Address - Fax:
Practice Address - Street 1:109 NEW FORT BROWDER RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1027
Practice Address - Country:US
Practice Address - Phone:334-695-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9091OtherVETERAN AFFAIRS