Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD000014180 | WA |
NPI | 1639126238 |
---|---|
Provider Name | Randall Stuart Riggs |
First Address | Spokane, WA 99202-6010 |
Second Address | Spokane, WA 99202-6010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 18/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1048982 | (05) | WA |
AB32999 | MEDICARE GROUP (01) | WA |
D33954 | (02) | WA |