Provider Demographics
NPI:1023281466
Name:RIDDICK, MAX FORREST (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:FORREST
Last Name:RIDDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3618 TIGER POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3443
Mailing Address - Country:US
Mailing Address - Phone:407-402-2080
Mailing Address - Fax:321-238-2002
Practice Address - Street 1:1553 WINTER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3802
Practice Address - Country:US
Practice Address - Phone:407-359-4999
Practice Address - Fax:321-238-2002
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2016-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 13065207Q00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine