Provider Demographics
NPI:1679551543
Name:KISER, RICK E (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:E
Last Name:KISER
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 1:1900 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5114
Mailing Address - Country:US
Mailing Address - Phone:970-350-2403
Mailing Address - Fax:970-392-4708
Practice Address - Street 1:1900 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5114
Practice Address - Country:US
Practice Address - Phone:970-350-2403
Practice Address - Fax:970-392-4708
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0122709Medicaid
COP00944703OtherMEDICARE RAILROAD CARRIER PTAN
COP00944703OtherMEDICARE RAILROAD CARRIER PTAN
COD28305Medicare UPIN
COC20418Medicare PIN
COCOA102136Medicare PIN