Provider Demographics
NPI:1669415881
Name:RIGGS, RYAN K (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:K
Last Name:RIGGS
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 1:6243 W 10220 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3436
Mailing Address - Country:US
Mailing Address - Phone:801-651-4876
Mailing Address - Fax:801-996-8785
Practice Address - Street 1:11762 S STATE ST STE 110
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-495-3539
Practice Address - Fax:801-996-8785
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD23225207P00000X, 208D00000X
UT6453925-1205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH13765Medicare UPIN