Individual
DR. MICHAEL GLENN RIDGEWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL PLAZA DR, TRAUMA SERVICE, ROSEVILLE, CA 95661-3037
(916) 781-1382
(916) 781-1383
Mailing address
PO BOX 2366, ROCKLIN, CA 95677-8366
(916) 781-1382
(916) 781-1383
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A51663
CA
2086S0102X
Surgical Critical Care Physician
A51663
CA
2086S0127X
Trauma Surgery Physician
A51663
CA
Other
Enumeration date
07/22/2006
Last updated
12/11/2009
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