Individual
KEVIN W RIDDLEBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1551 PROFESSIONAL LN, SUITE 200, LONGMONT, CO 80501-6972
(303) 772-1600
(303) 772-9317
Mailing address
1551 PROFESSIONAL LN, SUITE 200, LONGMONT, CO 80501-6972
(303) 772-1600
(303) 772-9317
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1801
CO
363AS0400X
Surgical Physician Assistant
Primary
1801
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54570867
—
CO
Enumeration date
07/28/2005
Last updated
11/09/2010
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