Provider Demographics
NPI:1245225135
Name:RICKERHAUSER, NANCY M (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:RICKERHAUSER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-2348
Mailing Address - Country:US
Mailing Address - Phone:830-997-0330
Mailing Address - Fax:830-997-7601
Practice Address - Street 1:815 FRONT ST
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-0156
Practice Address - Country:US
Practice Address - Phone:830-995-5633
Practice Address - Fax:830-997-7601
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ215OtherBCBSTX
TX117545704Medicaid
TX8AQ215OtherBCBSTX
TX8L3779Medicare PIN