Individual
DR. DERRY RIDGWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
251 MAPLE ST STE B, ASHLAND, OR 97520-1516
(949) 646-1016
Mailing address
5501 SEASHORE DR, NEWPORT BEACH, CA 92663-2219
(949) 646-1016
(949) 646-7679
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD10816
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
256471
OREGON WELFARE PROVIDER
OR
Enumeration date
07/30/2006
Last updated
07/08/2007
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