# MAL S RIDDELL, D.O. CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962634170
- **Authorized official:** MAL S. RIDDELL (PHYSICIAN)
- **Authorized official phone:** (662) 809-1453

## Contact information

- **Practice address:** 12028 WATER RIDGE DR, OXFORD, MS 38655-6019
- **Practice address phone:** (662) 809-1453
- **Practice address fax:** (662) 346-2851
- **Mailing address:** 12028 WATER RIDGE DR STE B, OXFORD, MS 38655-6019
- **Mailing address phone:** (662) 809-1453
- **Mailing address fax:** (662) 346-2851

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 08590 | MS | Yes |

## Other

- **Enumeration date:** 08/20/2009
- **Last updated:** 10/07/2026