Healthcare Provider Details

I. General information

NPI: 1639126238
Provider Name (Legal Business Name): RANDALL STUART RIGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E 2ND AVE STE C
SPOKANE WA
99202-6010
US

IV. Provider business mailing address

611 E 2ND AVE STE C
SPOKANE WA
99202-6010
US

V. Phone/Fax

Practice location:
  • Phone: 509-534-5000
  • Fax: 509-534-0288
Mailing address:
  • Phone: 509-534-5000
  • Fax: 509-534-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD000014180
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD00014180
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00014180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: