Individual
JAN S RISDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
399 W CAMPBELL RD, MEDICAL PLAZA II, SUITE 410, RICHARDSON, TX 75080-3595
(972) 238-7799
(972) 238-7135
Mailing address
9101 LBJ FWY, SUITE 710, DALLAS, TX 75243-2057
(972) 792-5700
(214) 349-7707
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
M5492
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189247301
—
TX
05
—
189247302
—
TX
05
—
189247303
—
TX
05
—
189247304
—
TX
05
—
189247306
—
TX
05
—
189247307
—
TX
01
—
613337
MEDICARE PTAN
TX
01
—
8BJ292
BCBS
TX
Enumeration date
06/06/2007
Last updated
05/15/2013
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