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General NPI Number Information
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NPI Number | 1528066578
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Entity Type | Individual
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Provider Name | ANDREW RAY RIFFEY MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 374 E GRAND AVE # 6740
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City | CARBONDALE
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State | IL
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Zip | 62901-3962
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Country | US
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Telephone | 618-453-3311
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Fax | 618-453-4449
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Provider Business Mailing Address
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Address Line | PO BOX 19639
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9639
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Country | US
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Telephone | 217-545-8000
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Fax | 844-470-2486
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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 | 036-112145
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License Number State | IL
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