Individual
MARK RIDDLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
11212 N MAY AVE, STE. 208, OKLAHOMA CITY, OK 73120-6336
(405) 708-6331
(405) 708-6331
Mailing address
11212 N MAY AVE, STE. 208, OKLAHOMA CITY, OK 73120-6336
(405) 708-6331
(405) 708-6331
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200308690B
—
OK
Enumeration date
03/05/2012
Last updated
03/05/2012
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