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General NPI Number Information
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NPI Number | 1851367346
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Entity Type | Individual
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Provider Name | LOUIS E RIDGWAY III M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 2817 JBS PKWY SUITE A-103
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City | ODESSA
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State | TX
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Zip | 79762-8111
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Country | US
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Telephone | 432-582-2277
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Fax | 432-333-2802
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Provider Business Mailing Address
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Address Line | 2817 JBS PKWY SUITE A-103
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City | ODESSA
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State | TX
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Zip | 79762-8111
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Country | US
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Telephone | 432-582-2277
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Fax | 432-333-2802
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 04-24081
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | H4043
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License Number State | TX
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