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General NPI Number Information
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NPI Number | 1043398456
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Entity Type | Individual
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Provider Name | GREGORY ALLEN RIDDLE MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1599 JONES STREET
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City | GRAND FORKS AFB
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State | ND
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Zip | 58205
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Country | US
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Telephone | 701-747-5326
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Fax |
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Provider Business Mailing Address
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Address Line | 1599 JONES STREET
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City | GRAND FORKS AFB
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State | ND
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Zip | 58205
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Country | US
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Telephone | 701-747-5326
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Fax |
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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 | 19406
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 19406
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 19406
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License Number State | AL
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