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NPI Code Detail

MEDICARE: MEREDITH RIDDLE M.D.

MEDICARE: MEREDITH RIDDLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianUO 3690FL
2207Q00000XFamily Medicine PhysicianOS 12980FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01736189OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265870778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH RIDDLE M.D.
Provider Business Mailing Address
First Line : PO BOX 45443
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84145-0443
Country : US
Telephone Number : 904-202-1032
Fax Number : 904-376-4107
Provider Business Practice Location Address
First Line : 4844 DEER LAKE DR W STE 1
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32246-4506
Country : US
Telephone Number : 904-738-8690
Fax Number : 904-390-7429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2013
Last Update Date : 02/12/2021

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Directions to “ MEREDITH RIDDLE M.D.” Practice Location

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