Provider Demographics
NPI:1295783488
Name:RITTER, JOHN ROSS (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROSS
Last Name:RITTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W. GRAND PKWY. S.
Mailing Address - Street 2:#G-120
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:866-950-3627
Mailing Address - Fax:800-652-8206
Practice Address - Street 1:1450 W GRAND PKWY S
Practice Address - Street 2:#G-120
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8286
Practice Address - Country:US
Practice Address - Phone:866-950-3627
Practice Address - Fax:800-652-8206
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1682213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165628212Medicaid
TX165628213Medicaid
TX165628210Medicaid
TX165628211Medicaid
TX165628204Medicaid
TX165628205Medicaid
TX165628206Medicaid
TXP00451653OtherRAIL RD MEDICARE
TX165628214Medicaid
TX8F3882Medicare PIN
TX8F3877Medicare PIN
TX8F3890Medicare PIN
TX165628205Medicaid
TX165628213Medicaid
TX165628211Medicaid
TX165628204Medicaid
TX8F3911Medicare PIN
TX165628206Medicaid
TXP00451653OtherRAIL RD MEDICARE