Provider Demographics
NPI:1710183827
Name:RIGGS, JACK T (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:T
Last Name:RIGGS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:927 E POLSTON AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9811
Mailing Address - Country:US
Mailing Address - Phone:208-664-3313
Mailing Address - Fax:208-664-2793
Practice Address - Street 1:1701 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2537
Practice Address - Country:US
Practice Address - Phone:208-667-9110
Practice Address - Fax:208-667-0125
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IDM4322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B63660Medicare UPIN