Provider Demographics
NPI:1275701435
Name:JUDITH E RILEY MD PLC
Entity Type:Organization
Organization Name:JUDITH E RILEY MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-325-0865
Mailing Address - Street 1:310 N WILMOT RD STE 306
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2628
Mailing Address - Country:US
Mailing Address - Phone:520-325-0865
Mailing Address - Fax:520-325-4281
Practice Address - Street 1:310 N WILMOT RD STE 306
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2628
Practice Address - Country:US
Practice Address - Phone:520-325-0865
Practice Address - Fax:520-325-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13749207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty