Jackson Pediatric Associates, LLC

NPI #1912335530 in Jackson, Wyoming

Provider Information

NPI Number: 1912335530
Entity Type: Organization
Organization Name: Jackson Pediatric Associates, LLC
Primary Specialty: Pediatrics
Enumeration Date: Oct 16, 2013
Last Updated: Oct 16, 2013

Practice Location

Address: 557 E BROADWAY AVE
City: Jackson
State: Wyoming
ZIP Code: 83001-8640
Phone: (307) 733-4627

Authorized Official

Name: DR. TRAVIS JOHN RIDDELL, M.D.
Title: PEDIATRICIAN
Phone: (307) 733-4627

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X
Pediatrics	208000000X	Primary

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