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1083613210
MAL S. RIDDELL
GRENADA, MS
NPI
1083613210
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MS 08590)
Enumeration Date
2005-07-19
Last Update Date
2017-01-06
Business Address
Dr. MAL S. RIDDELL D.O.
1300 SUNSET DR SUITE B
GRENADA, MS 38901-4086
Phone number: 662-226-6430
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Mailing Address
Dr. MAL S. RIDDELL D.O.
PO BOX 1263
GRENADA, MS 38902-1263
Phone number: 662-226-6430
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