Provider Demographics
NPI:1003852690
Name:RIDLEY, COURTNEY PAIGE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:PAIGE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WADE
Other - Middle Name:CLARK
Other - Last Name:RIDLEY
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:415-600-3514
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:415-600-3514
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125717202D00000X, 207V00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1487696985OtherCURRY HEALTH DISTRICT NPI
OR500683528Medicaid
CAA125717OtherCALIFORNIA STATE LICENSE
OR930937095OtherCURRY HEALTH DISTRICT TAX I.D.