Jefferson Eugene Riddle

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G5536 Issued in TX

Practice address

2411 Fountain View Dr
Suite 200
Houston, TX 77057-4817

Phone

(713) 458-4185

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219190400000",
    "number": "1215089974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR STE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574832",
            "telephone_number": "713-620-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "SUITE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-458-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "JEFFERSON",
        "middle_name": "EUGENE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "G5536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125599402",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA - MEDICAID",
            "identifier": "1476200",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUT HARRIS - MEDICARE",
            "identifier": "8014J5",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX-BLUE SHIELD",
            "identifier": "84Y576",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riczara Dental Group PC
• Amy L Ridall, DDS
• Samantha Ridder, M.S. L.M.F.T.-A.
• Amanda Riddle
• Barrett Charles Riddle, MD
• Lindsey Riddle
• Michael Vincent Riddle, RN
• Ride2Life Transit LLC
• Dionne Wynisha Rideau, APRN FNP-C
• Natalia Yevonne Rideaux, APRN, FNP-C

• Anesthesiology Physician in Houston, TX
• Providers in Houston, TX by specialty
• Anesthesiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.