Provider Demographics
NPI:1629173935
Name:RIGDON, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:RIGDON
Suffix:
Gender:M
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:PO BOX 15498
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0498
Mailing Address - Country:US
Mailing Address - Phone:559-455-4000
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:1121 W VINE ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5137
Practice Address - Country:US
Practice Address - Phone:209-334-4416
Practice Address - Fax:209-371-0119
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG735712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G735710Medicaid
CAF54227Medicare UPIN
CA00G735715Medicare PIN
CA00G735719Medicare PIN
CA300121028Medicare PIN
CA00G7357110Medicare PIN
CA00G735714Medicare PIN
CA00G735718Medicare PIN
CA00G735710Medicare PIN
CA00G735710Medicaid
CA00G735717Medicare PIN