Individual
JEFFERSON EUGENE RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 458-4185
Mailing address
2411 FOUNTAIN VIEW DR STE 200, HOUSTON, TX 77057-4832
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G5536
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125599402
—
TX
01
—
1476200
LA - MEDICAID
LA
01
—
8014J5
OUT HARRIS - MEDICARE
TX
01
—
84Y576
TX-BLUE SHIELD
—
Enumeration date
01/16/2007
Last updated
08/20/2008
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