Individual
DANIEL LYMAN RIDOUT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 W COUNTRY CLUB RD STE 201, ROSWELL, NM 88201-5221
(575) 624-4651
(575) 624-4875
Mailing address
350 W COUNTRY CLUB RD STE 201, ROSWELL, NM 88201-5221
(575) 624-4651
(575) 624-4875
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101237677
VA
207RG0100X
Gastroenterology Physician
Primary
MD2015-0106
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPI & TIN
BLUE CROSS BLUE SHIELD OF NM
NM
Enumeration date
09/13/2005
Last updated
10/14/2025
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