Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 04-29139 | KS |
Y | 2084N0400X | Neurologist | 04-29139 | KS |
NPI | 1588761498 |
---|---|
Provider Name | Larry W Ridings |
First Address | Shawnee, KS 66216-5162 |
Second Address | Shawnee, KS 66216-5162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 17/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100389870A | (05) | KS |
130023466 | RAILROAD MEDICARE (01) | |
205320609 | (05) | MO |
28659021 | BCBS KS CITY (01) | MO |
399330 | FIRSTGUARD (01) | KS |
F26653 | (02) |