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1326062977
BRIAN D RIDGELY
PORT ST LUCIE, FL
NPI
1326062977
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA3524)
Enumeration Date
2006-07-27
Last Update Date
2010-06-15
Business Address
-- BRIAN D RIDGELY PA
1651 SE TIFFANY AVE
PORT ST LUCIE, FL 34952-7564
Phone number: 772-398-1800
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Mailing Address
-- BRIAN D RIDGELY PA
PO BOX 417
STUART, FL 34995-0417
Phone number: 772-223-5665
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