Mal S. Riddell D.O.

NPI 1083613210 - Family Medicine - 207Q00000X

NPI Details
NPI 1083613210
Gender Male
Enumeration Date 07/19/2005
Last Updated 07/26/2008
Entity Type Individual
Active Over 11 years ago
Practice Location
1300 SUNSET DR
SUITE B
GRENADA MS, 38901-4086, US
Phone (662) 226-6430
Fax (662) 226-0018
Business Location
PO BOX 1263
GRENADA MS, 38902-1263, US
Phone (662) 226-6430
Fax (662) 226-0018
Toxanomy
Taxonomy Code 207Q00000X
License State Mississippi
License Number 08590
Remove 1083613210 NPI Number
 

According to our database, Dr. Mal S. Riddell D.O. NPI is 1083613210, taxonomy code is 207Q00000X and license number is 08590, license state is located at Mississippi. Mal S. Riddell D.O. physically located at 1300 Sunset Dr, Grenada MS, 38901-4086. NPI Number Mal S. Riddell D.O. has the Individual type.

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1083613210 NPI number is provided on an as is basis without warranty of any kind. 1083613210 is maintained by the National Plan & Provider Enumeration System. The contents of Mal S. Riddell D.O. are for informational purposes only.