Provider Demographics
NPI:1942032735
Name:RIDDLE, MATTHEW ROBERT
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11680 S 153RD WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8564
Mailing Address - Country:US
Mailing Address - Phone:918-671-9426
Mailing Address - Fax:
Practice Address - Street 1:1728 S CARSON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4610
Practice Address - Country:US
Practice Address - Phone:918-406-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator