Individual
ROGER DALE RIDGEWAY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4502 LT EUGENE J MAJURE DR, PASCAGOULA, MS 39581-5305
(228) 696-9224
(228) 696-9228
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7584
(228) 497-7586
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21922
MS
2084P0800X
Psychiatry Physician
31130
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02030025
—
MS
Enumeration date
06/19/2008
Last updated
10/11/2022
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