Provider Demographics
NPI:1336147719
Name:RIBLET, JEFFREY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:RIBLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 HIGH ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3213
Mailing Address - Country:US
Mailing Address - Phone:757-397-2383
Mailing Address - Fax:757-397-5201
Practice Address - Street 1:3640 HIGH ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3213
Practice Address - Country:US
Practice Address - Phone:757-397-2383
Practice Address - Fax:757-397-5201
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010496292086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA463390OtherANTHEM
VA890692OtherMEDICARE RR
VA007314001Medicaid
VA15979OtherOPTIMA
VA890692OtherMEDICARE RR