Provider Demographics
NPI:1760793350
Name:RIDEOUT, WILLIAM ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC
Last Name:RIDEOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6854 TWIN LAKES AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ON
Mailing Address - Zip Code:K4P 1P1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 TRENT DRIVE
Practice Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER BUILDING CR2 ROOM 0584
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27702
Practice Address - Country:US
Practice Address - Phone:919-684-6726
Practice Address - Fax:919-684-6002
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program