Provider Demographics
NPI:1144524596
Name:EDWARD E. RIGDON, M.D., INC.
Entity type:Organization
Organization Name:EDWARD E. RIGDON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-825-1975
Mailing Address - Street 1:PO BOX 6019
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-3919
Mailing Address - Country:US
Mailing Address - Phone:601-825-1975
Mailing Address - Fax:601-825-4127
Practice Address - Street 1:348 CROSSGATES BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2700
Practice Address - Country:US
Practice Address - Phone:601-825-1975
Practice Address - Fax:601-825-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS084122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121392Medicaid
MS00121392Medicaid
B66156Medicare UPIN