Individual
DR. JAY RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9501 FARRELL RD, SUITE GC-11, FORT BELVOIR, VA 22060-5901
(703) 805-0193
Mailing address
PO BOX 1327, FORT BELVOIR, VA 22060-1027
(703) 805-0193
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
54289
VA
Other
Enumeration date
10/26/2005
Last updated
03/26/2010
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