Provider Demographics
NPI:1912015702
Name:MADISON, RICKY ROLAND
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:ROLAND
Last Name:MADISON
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 1:3419 W OVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9440
Mailing Address - Country:US
Mailing Address - Phone:713-794-1414
Mailing Address - Fax:
Practice Address - Street 1:3419 W OVERDALE DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9440
Practice Address - Country:US
Practice Address - Phone:713-794-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other