MEDICARE: DR. ERIC DAVID RIDEMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	OS13629	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396057394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DAVID RIDEMAN D.O.

Provider Business Mailing Address
First Line	:	4106 W LAKE MARY BLVD STE 330
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3383
Country	:	US
Telephone Number	:	407-833-9195
Fax Number	:	407-833-9308

Provider Business Practice Location Address
First Line	:	4106 W LAKE MARY BLVD STE 330
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3383
Country	:	US
Telephone Number	:	407-833-9195
Fax Number	:	407-833-9308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	06/23/2016

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