Individual
TRACY M. RIORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1254 MAIN ST, IMPERIAL, MO 63052-3861
(636) 741-3130
Mailing address
1254 MAIN STREET, IMPERIAL, MO 63052
(636) 741-3130
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2002013047
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124094362
—
MO
Enumeration date
02/27/2006
Last updated
09/20/2017
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