Individual
BRUCE W RIDDLE
Active
Individual
BRUCE W RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01044582A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000056040
ANTHEM
—
01
—
054468P
SIHO
—
01
—
1790837789
GROUP NPI
IN
05
—
200056040
—
IN
01
—
P00137831
MEDICARE RAILROAD
IN
Enumeration date
06/27/2006
Last updated
05/06/2014
Update your record
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