Provider Demographics
NPI:1922197425
Name:RIDGWAY, JOHN GREGORY (D O P C)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:RIDGWAY
Suffix:
Gender:M
Credentials:D O P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 E 27TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3292
Mailing Address - Country:US
Mailing Address - Phone:928-246-8234
Mailing Address - Fax:928-782-4320
Practice Address - Street 1:2274 E 27TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3292
Practice Address - Country:US
Practice Address - Phone:928-246-8234
Practice Address - Fax:928-782-4320
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922197425Medicare UPIN
AZ100220Medicare PIN
AZA10398Medicare UPIN