Provider Demographics
NPI:1316938632
Name:RICKS, JON T (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:T
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 1:5575 FRISCO SQUARE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3309
Mailing Address - Country:US
Mailing Address - Phone:972-377-6800
Mailing Address - Fax:972-668-6707
Practice Address - Street 1:5575 FRISCO SQUARE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3309
Practice Address - Country:US
Practice Address - Phone:972-377-6800
Practice Address - Fax:972-867-1018
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096704403Medicaid
TX096704403Medicaid
TX8874NOMedicare ID - Type Unspecified