Provider Demographics
NPI:1659310928
Name:RIDDLE, DOUGLAS RYAN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RYAN
Last Name:RIDDLE
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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-657-3950
Mailing Address - Fax:405-471-0040
Practice Address - Street 1:4509 INTEGRIS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8696
Practice Address - Country:US
Practice Address - Phone:405-657-3950
Practice Address - Fax:405-471-0040
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200079200AMedicaid
OK200079200AMedicaid
OKOK100039Medicare PIN