Provider Demographics
NPI:1346225240
Name:RIGGENBACH, CHARLES MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARK
Last Name:RIGGENBACH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1032 MAR WALT DRIVE, SUITE 210
Mailing Address - Street 2:GASTROENTEROLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8260
Mailing Address - Fax:850-862-6148
Practice Address - Street 1:1032 MAR WALT DRIVE, SUITE 210
Practice Address - Street 2:GASTROENTEROLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8260
Practice Address - Fax:850-862-6148
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62399207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370740700Medicaid
FL15129OtherBCBSFL
FL15129OtherBCBSFL
FL370740700Medicaid