Provider Demographics
NPI:1811095201
Name:RICKLESS, MORTON SUMNER (MD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:SUMNER
Last Name:RICKLESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:716 E 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4756
Mailing Address - Country:US
Mailing Address - Phone:256-238-9500
Mailing Address - Fax:256-238-9524
Practice Address - Street 1:716 E 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4756
Practice Address - Country:US
Practice Address - Phone:256-238-9500
Practice Address - Fax:256-238-9524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL14546207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51081017OtherBLUECROSS
AL000081017Medicaid
AL51081017OtherBLUECROSS
AL000081017Medicare ID - Type Unspecified