Organization
JACKSON PEDIATRIC ASSOCIATES, LLC
Active
Other names
Jackson Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS JOHN RIDDELL M.D. (PEDIATRICIAN)
(307) 733-4627
Entity
Organization
Contact information
Practice address
557 E BROADWAY AVE, JACKSON, WY 83001-8640
(307) 733-4627
(307) 733-5184
Mailing address
PO BOX 1029, JACKSON, WY 83001-1029
(307) 733-4627
(307) 733-5184
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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