Organization
MAL S RIDDELL, D.O. CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAL S RIDDELL III D.O. (OWNER)
(662) 226-6430
Entity
Organization
Contact information
Practice address
1300 SUNSET DR, SUITE B, GRENADA, MS 38901-4086
(662) 226-6430
(662) 226-0018
Mailing address
1300 SUNSET DR, SUITE B, GRENADA, MS 38901-4086
(662) 226-6430
(662) 226-0018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
08590
MS
Other
Enumeration date
08/20/2009
Last updated
01/06/2017
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