| Mal S Riddell, D.o. Clinic | |
|
1300 Sunset Dr Suite B Grenada MS 38901-4086 | |
| (662) 226-6430 | |
| (662) 226-0018 |
| Full Name | Mal S Riddell, D.o. Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Sunset Dr, Grenada, Mississippi |
| Authorized Official Name and Position | Mal S Riddell (OWNER) |
| Authorized Official Contact | 6622266430 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mal S Riddell, D.o. Clinic 1300 Sunset Dr Suite B Grenada MS 38901-4086 Ph: (662) 226-6430 | Mal S Riddell, D.o. Clinic 1300 Sunset Dr Suite B Grenada MS 38901-4086 Ph: (662) 226-6430 |
| NPI Number | 1962634170 |
|---|---|
| Provider Enumeration Date | 08/20/2009 |
| Last Update Date | 01/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962634170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 08590 (Mississippi) | Primary |
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