Provider Demographics
NPI:1851367346
Name:RIDGWAY, LOUIS E III (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:E
Last Name:RIDGWAY
Suffix:III
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 1:2817 JBS PKWY
Mailing Address - Street 2:SUITE A-103
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8111
Mailing Address - Country:US
Mailing Address - Phone:432-582-2277
Mailing Address - Fax:432-333-2802
Practice Address - Street 1:2817 JBS PKWY
Practice Address - Street 2:SUITE A-103
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8111
Practice Address - Country:US
Practice Address - Phone:432-582-2277
Practice Address - Fax:432-333-2802
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24081207VM0101X
TXH4043207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206852816Medicaid
MO1851367346Medicaid
KS100169010DMedicaid
KS100160590DMedicaid
MOP00740098OtherMEDICARE RR
MOP00731935OtherMEDICARE RR
KS100160590AMedicaid
KS100160590AMedicaid
MOP00731935OtherMEDICARE RR
MO1851367346Medicaid
MOP00000009Medicare PIN
MOE94A00003Medicare PIN