Provider Demographics
NPI:1457910010
Name:JEANNY RICKARDS DPM, PLLC
Entity Type:Organization
Organization Name:JEANNY RICKARDS DPM, PLLC
Other - Org Name:SEASIDE FOOT AND ANKLE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOOT AND ANKLE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:857-318-1675
Mailing Address - Street 1:6501 MCARDLE RD APT 4304
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7121 SPID DR STE 106
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4939
Practice Address - Country:US
Practice Address - Phone:857-318-1675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty