Provider Demographics
NPI:1396057394
Name:RIDEMAN, ERIC DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:RIDEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 W LAKE MARY BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3383
Mailing Address - Country:US
Mailing Address - Phone:407-833-9195
Mailing Address - Fax:407-833-9308
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3383
Practice Address - Country:US
Practice Address - Phone:407-833-9195
Practice Address - Fax:407-833-9308
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13629208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program