MEDICARE: BRUCE W RIDDLE MD

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	207R00000X	Internal Medicine Physician	01044582A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00137831	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054468P	OTHER		SIHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1790837789	OTHER	IN	GROUP NPI
4	00000056040	OTHER		ANTHEM

General Provider Information

NPI Number	:	1932136744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE W RIDDLE MD

Provider Business Mailing Address
First Line	:	2326 18TH ST
Second Line	:	STE 210
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5359
Country	:	US
Telephone Number	:	812-372-8426
Fax Number	:	812-372-8301

Provider Business Practice Location Address
First Line	:	2326 18TH ST
Second Line	:	STE 210
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5359
Country	:	US
Telephone Number	:	812-372-8426
Fax Number	:	812-372-8301

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/06/2014

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Directions to “ BRUCE W RIDDLE MD” Practice Location

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