Provider Demographics
NPI:1881191617
Name:RIDDLE, BARRETT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:CHARLES
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-2916
Mailing Address - Fax:314-747-4189
Practice Address - Street 1:510 S KINGSHIGHWAY BLVD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1016
Practice Address - Country:US
Practice Address - Phone:314-362-2916
Practice Address - Fax:314-747-4189
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20230027912085R0202X
TXBP100638782085R0202X
TXBP200684562085R0202X
TXT36892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology