Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A44838 | CA |
NPI | 1003823550 |
---|---|
Provider Name | John M Riddle |
First Address | Hanford, CA 93230-4328 |
Second Address | Hanford, CA 93230-4328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 22/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A448380 | (05) | CA |
B65644 | (02) |