Provider Demographics
NPI:1902878226
Name:SCHMIDT, RICKY RON (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:RON
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:R
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1560
Mailing Address - Country:US
Mailing Address - Phone:405-527-7555
Mailing Address - Fax:405-310-0869
Practice Address - Street 1:1800 N GREEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1630
Practice Address - Country:US
Practice Address - Phone:405-527-7555
Practice Address - Fax:405-310-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113440AMedicaid