Provider Demographics
NPI:1336121573
Name:RIDDLE, JOE D (M D)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:D
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:M D
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 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6630
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6424
Practice Address - Country:US
Practice Address - Phone:405-329-7621
Practice Address - Fax:405-360-6315
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100117070AMedicaid
OK243623505Medicare PIN