Individual
JEFFERSON EUGENE RIDDLE
Active
Individual
JEFFERSON EUGENE RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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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