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General NPI Number Information
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NPI Number | 1003823550
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Entity Type | Individual
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Provider Name | JOHN M RIDDLE MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 869 W LACEY BLVD
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City | HANFORD
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State | CA
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Zip | 93230-4328
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Country | US
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Telephone | 559-582-9313
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Fax | 559-582-2570
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Provider Business Mailing Address
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Address Line | 2910 AZALEA PARK
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City | MUSKOGEE
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State | OK
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Zip | 74401
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Country | US
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Telephone | 918-683-6500
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Fax | 918-683-8665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A44838
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14837
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License Number State | OK
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