Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME 13065 | FL |
Y | 207X00000X | Orthopaedic Surgeon | ME 13065 | FL |
NPI | 1023281466 |
---|---|
Provider Name | Max Forrest Riddick |
First Address | Gulf Breeze, FL 32563-3443 |
Second Address | Winter Springs, FL 32708-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 16/02/2016 |