Individual
BLAKE RANDALL RIDGWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1800 W UNIVERSITY BLVD, DURANT, OK 74701-3006
(281) 249-5954
Mailing address
1903 W EVERGREEN ST, DURANT, OK 74701-4615
(316) 644-3355
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
100088
OK
367500000X
Certified Registered Nurse Anesthetist
826001
TX
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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