1902196710 NPI number — DR. DOUGLAS GEORGE RIEDMILLER PSYD

Table of content: BRITTANY D FISHER (NPI 1225283138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902196710 NPI number — DR. DOUGLAS GEORGE RIEDMILLER PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEDMILLER
Provider First Name:
DOUGLAS
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902196710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3831 KINGSTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34238-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-914-2271
Provider Business Mailing Address Fax Number:
941-925-5858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7705 HOLIDAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34231-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-914-2271
Provider Business Practice Location Address Fax Number:
941-925-5858
Provider Enumeration Date:
04/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY5058 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com