MEDICARE: ROBBY C RIDDLE 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
1	207Q00000X	Family Medicine Physician	MD00041763	WA

General Provider Information

NPI Number	:	1942293055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBBY C RIDDLE MD

Provider Business Mailing Address
First Line	:	3600 LIND AVE SW
Second Line	:	STE 100
City	:	RENTON
State	:	WA
Zip	:	98057-4934
Country	:	US
Telephone Number	:	425-656-5412
Fax Number	:	425-656-4079

Provider Business Practice Location Address
First Line	:	5952 BLACKSTONE WAY
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-4900
Country	:	US
Telephone Number	:	509-464-3627
Fax Number	:	509-466-9517

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/14/2021

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