Individual
MR. DEON TRAVELL RIDGELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2817 REILLY ST, FORT LIBERTY, NC 28310-5647
(910) 907-4005
Mailing address
2817 REILLY ST, FORT LIBERTY, NC 28310-0601
(910) 853-1285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-03495
NC
Other
Enumeration date
11/29/2006
Last updated
01/08/2024
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