Basic Information
| Provider Information | |||||||||
| NPI: | 1770618332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIESBERG | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2505 ROSSMERE ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809194869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195241740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7490 SUTHERLAND CIR | ||||||||
| Address2: | RFMC | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195242207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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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 | 43292 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.