Provider Demographics
NPI:1134284268
Name:RIFFER, ERNIE (MD)
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:
Last Name:RIFFER
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 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:7600 N 15TH ST STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4348
Practice Address - Country:US
Practice Address - Phone:602-200-3800
Practice Address - Fax:602-200-3838
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137340Medicaid
E39624Medicare UPIN
AZWDBVK01Medicare ID - Type Unspecified