Provider Demographics
NPI:1285613422
Name:RICAURTE, EDUARDO L (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:L
Last Name:RICAURTE
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 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1644
Mailing Address - Country:US
Mailing Address - Phone:563-355-9996
Mailing Address - Fax:563-355-9997
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1644
Practice Address - Country:US
Practice Address - Phone:563-355-9996
Practice Address - Fax:563-355-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA23724207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1104554Medicaid
A17360Medicare UPIN
IA1104554Medicaid