Provider Demographics
NPI:1043212079
Name:RIFFLE, ANNE E (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:E
Last Name:RIFFLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 N. LOCUST GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3653
Mailing Address - Country:US
Mailing Address - Phone:208-338-5437
Mailing Address - Fax:208-939-9811
Practice Address - Street 1:3653 N. LOCUST GROVE ROAD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3653
Practice Address - Country:US
Practice Address - Phone:208-338-5437
Practice Address - Fax:208-939-9811
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM14796208000000X
NY225408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348929Medicaid
NY6B1221Medicare PIN
NYI02396Medicare UPIN