Provider Demographics
NPI:1598745523
Name:RIDGWAY, EMILY BOYE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BOYE
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 N 15TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3290
Mailing Address - Country:US
Mailing Address - Phone:406-586-2620
Mailing Address - Fax:406-586-2120
Practice Address - Street 1:1188 N 15TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-2620
Practice Address - Fax:406-587-2120
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224513207T00000X
MT52558208200000X
MA227587208200000X
NH15092208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016268Medicaid
NH30208588Medicaid
NH30208588Medicaid