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NPI Code Detail

MEDICARE: DR. ROBERT M RIDOUT MD

MEDICARE: DR. ROBERT M RIDOUT MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianF7096TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00063095OTHERTXRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11710967146OTHERNPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710967146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT M RIDOUT MD
Provider Business Mailing Address
First Line : PO BOX 3780
Second Line :
City : TUPELO
State : MS
Zip : 38803-3780
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SAINT MICHAEL DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-2372
Country : US
Telephone Number : 903-614-2850
Fax Number : 903-614-6349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 11/30/2020

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