Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 34950 | AL |
Y | 207RI0011X | Interventional Cardiology | 34950 | AL |
NPI | 1043454895 |
---|---|
Provider Name | Thomas Christopher Riddell |
First Address | Mobile, AL 36608-6758 |
Second Address | Mobile, AL 36608-6705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102IC37309 | MEDICARE AL PTAN CMS/CAHABA (01) | AL |