MEDICARE: DR. JEFFREY LYNN RIBLET 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
1	2086S0102X	Surgical Critical Care Physician	0101049629	VA
2	208600000X	Surgery Physician	0101049629	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	890692	OTHER	VA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	463390	OTHER	VA	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	15979	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1336147719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LYNN RIBLET M.D.

Provider Business Mailing Address
First Line	:	3640 HIGH ST
Second Line	:	SUITE 2F
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-3213
Country	:	US
Telephone Number	:	757-397-2383
Fax Number	:	757-397-5201

Provider Business Practice Location Address
First Line	:	3640 HIGH ST
Second Line	:	SUITE 2F
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-3213
Country	:	US
Telephone Number	:	757-397-2383
Fax Number	:	757-397-5201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/21/2021

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Directions to “ DR. JEFFREY LYNN RIBLET M.D.” Practice Location

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