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Individual
DR. DERRY RIDGWAY
Active
Individual
DR. DERRY RIDGWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD10816
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
256471
OREGON WELFARE PROVIDER
OR
Enumeration date
07/30/2006
Last updated
07/08/2007
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