Healthcare Provider Details

I. General information

NPI: 1952370108
Provider Name (Legal Business Name): DOUGLAS A RIFFELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST
ARCANUM OH
45304-1425
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-692-5007
  • Fax: 937-548-3552
Mailing address:
  • Phone: 937-548-3806
  • Fax: 937-548-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35049160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: