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General NPI Number Information
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NPI Number | 1528214632
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Entity Type | Individual
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Provider Name | JAMES DAVID RIDGE MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2008
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 2651 E DISCOVERY PKWY
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City | BLOOMINGTON
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State | IN
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Zip | 47408-9059
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Country | US
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Telephone | 812-249-6684
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Fax |
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Provider Business Mailing Address
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Address Line | 1677 E CIDER CT
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City | BLOOMINGTON
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State | IN
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Zip | 47408-9480
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01067926A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01067926
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License Number State | IN
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