Provider Demographics
NPI:1669403861
Name:RICKS, MATTHEW RAY (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAY
Last Name:RICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2321
Mailing Address - Country:US
Mailing Address - Phone:785-408-5800
Mailing Address - Fax:785-730-8700
Practice Address - Street 1:5120 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2321
Practice Address - Country:US
Practice Address - Phone:785-408-5800
Practice Address - Fax:785-730-8700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23188207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002055OtherMEDICARE PTAN
KS200617960AMedicaid