Individual
GARY D RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 ST MARYS EPWORTH XING # B100, NEWBURGH, IN 47630-9497
(812) 469-8300
Mailing address
100 ST MARYS EPWORTH XING # B100, NEWBURGH, IN 47630-9497
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
IN01043786
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080112157
RAILROAD MEDICARE
IN
05
—
100369570
—
IN
Enumeration date
07/25/2006
Last updated
08/16/2022
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