Provider Demographics
NPI:1194770412
Name:JOE D RIDDLE MD INC
Entity type:Organization
Organization Name:JOE D RIDDLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-329-7621
Mailing Address - Street 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6424
Mailing Address - Country:US
Mailing Address - Phone:405-329-7621
Mailing Address - Fax:405-360-6315
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6424
Practice Address - Country:US
Practice Address - Phone:405-329-7621
Practice Address - Fax:405-360-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK202257462001OtherBCBS
OKD35197Medicare UPIN