Individual
DAVID RIDEOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 EAST 3RD STREET, DULUTH, MN 55805
(218) 786-8364
Mailing address
400 EAST 3RD STREET, DULUTH, MN 55805
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36567
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492470
—
IA
01
—
11430
WELLMARK BCBS
IA
Enumeration date
05/16/2006
Last updated
08/27/2008
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