Provider Demographics
NPI:1487708145
Name:DY, RITKY C (MD)
Entity type:Individual
Prefix:
First Name:RITKY
Middle Name:C
Last Name:DY
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 1:1221 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3723
Mailing Address - Country:US
Mailing Address - Phone:205-280-6789
Mailing Address - Fax:205-280-1350
Practice Address - Street 1:1221 7TH ST S
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3723
Practice Address - Country:US
Practice Address - Phone:205-280-6789
Practice Address - Fax:205-280-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18537207RG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000093998Medicaid
AL51093998OtherBCBS OF ALABAMA
AL000093998Medicare ID - Type Unspecified
AL000093998Medicaid