Provider Demographics
NPI:1689601338
Name:VIATOR, RICKEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:J
Last Name:VIATOR
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:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4500
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:23 MACK BAYOU LOOP
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-2604
Practice Address - Country:US
Practice Address - Phone:850-278-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09135OtherBCBS
FL061248100Medicaid
FL101554OtherAVMED
FLP00379114OtherRAILROAD MEDICARE
E75819Medicare UPIN
FL101554OtherAVMED