Provider Demographics
NPI:1851350441
Name:RIDDLE, MARK SIMONDS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SIMONDS
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:VERDI
Mailing Address - State:NV
Mailing Address - Zip Code:89439-1430
Mailing Address - Country:US
Mailing Address - Phone:301-841-5486
Mailing Address - Fax:
Practice Address - Street 1:NAMRU-3
Practice Address - Street 2:PSC 452, BOX 105
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09835-0007
Practice Address - Country:EG
Practice Address - Phone:202-342-1375
Practice Address - Fax:202-342-9625
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA669762083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine