Provider Demographics
NPI:1740552975
Name:RICCA, DALLIE F (MD)
Entity type:Individual
Prefix:DR
First Name:DALLIE
Middle Name:F
Last Name:RICCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DALLIE
Other - Middle Name:MARIE
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8098
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8098
Mailing Address - Country:US
Mailing Address - Phone:870-351-5260
Mailing Address - Fax:
Practice Address - Street 1:6 RIVER OAKS TRCE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4504
Practice Address - Country:US
Practice Address - Phone:870-351-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology