Provider Demographics
NPI:1194909994
Name:JOHN G. RIDGWAY, D.O. P. C.
Entity type:Organization
Organization Name:JOHN G. RIDGWAY, D.O. P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-726-9765
Mailing Address - Street 1:2451 S AVE A
Mailing Address - Street 2:SUITE 5
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7133
Mailing Address - Country:US
Mailing Address - Phone:928-726-9765
Mailing Address - Fax:928-726-9763
Practice Address - Street 1:2451 S AVE A
Practice Address - Street 2:SUITE 5
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7133
Practice Address - Country:US
Practice Address - Phone:928-726-9765
Practice Address - Fax:928-726-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ29464Medicare PIN