Provider Demographics
NPI:1932136744
Name:RIDDLE, BRUCE W (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2326 18TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5359
Mailing Address - Country:US
Mailing Address - Phone:812-372-8426
Mailing Address - Fax:812-372-8301
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:STE 210
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5359
Practice Address - Country:US
Practice Address - Phone:812-372-8426
Practice Address - Fax:812-372-8301
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044582A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
054468POtherSIHO
IN200056040Medicaid
IN1790837789OtherGROUP NPI
00000056040OtherANTHEM
INP00137831OtherMEDICARE RAILROAD
IN1790837789OtherGROUP NPI
00000056040OtherANTHEM