Provider Demographics
NPI:1598746331
Name:RIOS, GADDIEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GADDIEL
Middle Name:DAVID
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FOUNDERS PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8098
Mailing Address - Country:US
Mailing Address - Phone:605-307-0342
Mailing Address - Fax:
Practice Address - Street 1:211 FOUNDERS PARK DR STE C
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8098
Practice Address - Country:US
Practice Address - Phone:605-307-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051979A207Q00000X
SD17026207Q00000X
TXM2460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM2460OtherMEDICAL LICENSE
SD17026OtherMEDICAL LICENSE