Provider Demographics
NPI:1366440489
Name:RITTER, JACK LENDON (M D)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:LENDON
Last Name:RITTER
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 1:8850 SIX PINES DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2680
Mailing Address - Country:US
Mailing Address - Phone:281-367-6836
Mailing Address - Fax:281-681-5187
Practice Address - Street 1:8850 SIX PINES DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2680
Practice Address - Country:US
Practice Address - Phone:281-367-6836
Practice Address - Fax:281-681-5187
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2816989-024OtherCIGNA
TX3231590OtherAETNA HMO
TX2816989-023OtherCIGNA
TX2816989-025OtherCIGNA
TX34239OtherAMERICAID
TX4211340OtherAETNA PPO
TX8J1222OtherBCBS PROVIDER #
TXP00064361OtherMEDICARE RAILROAD
TX4211340OtherAETNA PPO
TXA87976Medicare UPIN