Individual
DR. LAWRENCE MARSHALL RIDDLES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-7456
(618) 256-7479
Mailing address
187 POW MIA DR, SCOTT AFB, IL 62225-1750
(618) 256-7456
(618) 256-7479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
159883-1
NY
Other
Enumeration date
09/22/2005
Last updated
07/08/2007
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