Healthcare Provider Details

I. General information

NPI: 1720511017
Provider Name (Legal Business Name): RICHARD ROSS RIESKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST
MOBILE AL
36604-1541
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5763
  • Fax: 251-660-5752
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number67972
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD37763
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: