Healthcare Provider Details

I. General information

NPI: 1851506786
Provider Name (Legal Business Name): SETH A RIDDLE, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 401
PROVO UT
84604-3306
US

IV. Provider business mailing address

1055 N 300 W STE 401
PROVO UT
84604-3306
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7499
  • Fax: 801-373-5980
Mailing address:
  • Phone: 801-357-7499
  • Fax: 801-373-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENISE RICHARDS
Title or Position: BILLING MANAGER
Credential:
Phone: 801-357-7499