Provider Demographics
NPI:1710368105
Name:RIDDLE, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:STORBAKKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:ATTN: TRACI MITCHELL - ADMN
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4200
Mailing Address - Fax:254-313-4326
Practice Address - Street 1:1600 PROVIDENCE DR
Practice Address - Street 2:ATTN: TRACI MITCHELL - ADMN
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707
Practice Address - Country:US
Practice Address - Phone:254-313-4200
Practice Address - Fax:254-313-4326
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1136207Q00000X
TXBP10054658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine