Individual
DAVID T RIDEOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3050 CHAMPION RING RD, FORT MYERS, FL 33905-5599
(207) 240-3362
Mailing address
PO BOX 511644, PUNTA GORDA, FL 33951-1644
(207) 240-3362
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME129811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G873540
—
CA
05
—
102202300
—
FL
Enumeration date
09/20/2006
Last updated
07/01/2019
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