Provider Demographics
NPI:1437150661
Name:RIDDOCH, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:RIDDOCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:2829 BABCOCK RD STE 500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-705-5600
Practice Address - Fax:210-692-1829
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH0759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285684225OtherGROUP NPI