Basic Information
| Provider Information | |||||||||
| NPI: | 1952411225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICKMAN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 G RD | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815059641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023343504 | ||||||||
| FaxNumber: | 8023343512 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 MEDICAL VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058559835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023343504 | ||||||||
| FaxNumber: | 8023343512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME138300 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | DR.0036616 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0420009448 | VT | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MVP | 01 | VT | 324005 | OTHER | 00029500 | 01 | VT | BLUE SHIELD | OTHER | 0VN159 | 05 | VT | MEDICAID |