Individual
BRIAN D RIDGELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1651 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7564
(772) 398-1800
(772) 398-1815
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-5665
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3524
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290394600
—
FL
Enumeration date
07/27/2006
Last updated
06/15/2010
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