Provider Demographics
NPI:1689650905
Name:SEDGWICK, RICKY LEE (DO)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:LEE
Last Name:SEDGWICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2441
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-2441
Mailing Address - Country:US
Mailing Address - Phone:563-324-8160
Mailing Address - Fax:563-324-8486
Practice Address - Street 1:1227 EAST RUSHOLME STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2498
Practice Address - Country:US
Practice Address - Phone:563-421-1000
Practice Address - Fax:563-421-7889
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02932207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6125393Medicaid
IA6125393Medicaid
58886Medicare ID - Type Unspecified