Provider Demographics
NPI:1881603017
Name:RANKIN, RICHARD B (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:RANKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:R
Other - Last Name:RANKIN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15498
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95857
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:1121 W VINE STREET
Practice Address - Street 2:SUITE 15
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-4416
Practice Address - Fax:209-371-0119
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG543132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G543130Medicaid
CA00G543134Medicare PIN
CA00G543138Medicare PIN
CAA89972Medicare UPIN
CA00G543130Medicaid
CA00G5431310Medicare PIN
CA00G543136Medicare PIN
CA00G543137Medicare PIN
CA00G543139Medicare PIN
CA300017829Medicare PIN
CA00G543130Medicare PIN
CA00G543135Medicare PIN