Provider Demographics
NPI:1104023308
Name:RIGGEAL, BRYAN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:RIGGEAL
Suffix:
Gender:M
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:PO BOX 746649
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6649
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:841 PRUDENTIAL DR FL 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-398-5404
Practice Address - Fax:904-391-5545
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128272207W00000X, 2084N0400X, 207WX0109X
GA66311207W00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018248700Medicaid