Healthcare Provider Details

I. General information

NPI: 1164414306
Provider Name (Legal Business Name): ROBERT LOW RIDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1662
US

IV. Provider business mailing address

2855 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1662
US

V. Phone/Fax

Practice location:
  • Phone: 719-265-1902
  • Fax: 719-574-8405
Mailing address:
  • Phone: 719-265-1902
  • Fax: 719-574-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCO21825
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: