Healthcare Provider Details

I. General information

NPI: 1497834279
Provider Name (Legal Business Name): EMMETT TALMADGE RILEY JR. RRT, RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1782 LAKESHORE DR
ABILENE TX
79602-5231
US

IV. Provider business mailing address

1782 LAKESHORE DR
ABILENE TX
79602-5231
US

V. Phone/Fax

Practice location:
  • Phone: 325-673-1084
  • Fax:
Mailing address:
  • Phone: 325-673-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number50549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: