Organization
DRU RIDDLE ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN DRU RIDDLE PHD, DNP, CRNA (MANAGING PARTNER)
(817) 734-7980
Entity
Organization
Contact information
Practice address
2800 W BOWIE ST, FORT WORTH, TX 76109-1706
(817) 734-7980
Mailing address
320 SILVER CANYON DR, FORT WORTH, TX 76108-9612
(817) 734-7980
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/13/2017
Last updated
10/13/2017
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