Provider Demographics
NPI:1427398429
Name:RIFFLE, GREGORY KEITH (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:KEITH
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N EWING ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3382
Mailing Address - Country:US
Mailing Address - Phone:740-681-9447
Mailing Address - Fax:740-681-9966
Practice Address - Street 1:135 N EWING ST
Practice Address - Street 2:SUITE 305
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3382
Practice Address - Country:US
Practice Address - Phone:740-681-9447
Practice Address - Fax:740-681-9966
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34011676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH350200OtherMEDICARE PTAN