Basic Information
| Provider Information | |||||||||
| NPI: | 1710183827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIGGS | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 927 E POLSTON AVE | ||||||||
| Address2: | STE 303 | ||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838549811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086643313 | ||||||||
| FaxNumber: | 2086642793 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086679110 | ||||||||
| FaxNumber: | 2086670125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M4322 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.