Healthcare Provider Details

I. General information

NPI: 1407847239
Provider Name (Legal Business Name): ROBERT ERICK RIDOUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-5200
  • Fax:
Mailing address:
  • Phone: 435-251-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01052347A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number6781446-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0092633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: