Provider Demographics
NPI:1902827918
Name:RICKARD, DANNY D (PA)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:D
Last Name:RICKARD
Suffix:
Gender:M
Credentials:PA
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 170
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-0170
Mailing Address - Country:US
Mailing Address - Phone:605-882-2630
Mailing Address - Fax:605-882-0447
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-2630
Practice Address - Fax:605-882-0447
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0555363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6825300Medicaid
MN249T3RIOtherBCBS
SD4995766OtherBCBS
MN640825700Medicaid
P47595Medicare UPIN
MN249T3RIOtherBCBS
MN970005295Medicare PIN
SDS41818Medicare PIN
MN970005132Medicare PIN
MN640825700Medicaid
SD4995766OtherBCBS