MEDICARE: DR. MARK SIMONDS RIDDLE M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician	A66976	CA

General Provider Information

NPI Number	:	1851350441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SIMONDS RIDDLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1430
Second Line	:
City	:	VERDI
State	:	NV
Zip	:	89439-1430
Country	:	US
Telephone Number	:	301-841-5486
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAMRU-3
Second Line	:	PSC 452, BOX 105
City	:	FPO
State	:	AE
Zip	:	09835-0007
Country	:	EG
Telephone Number	:	202-342-1375
Fax Number	:	202-342-9625

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/21/2022

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