Provider Demographics
NPI:1053323741
Name:RIDDLE, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:CHARLES
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4715 GWYNNE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-3209
Mailing Address - Country:US
Mailing Address - Phone:901-683-8961
Mailing Address - Fax:901-577-7415
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:VAMC MEMPHIS - 111E1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7415
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010039207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease