| Doctor Name: | DR. ROBERT GLADSTONE RIDOUT |
| NPI Number: | 1144426826 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | E1250 |
| Business Practice Address: | 2200 Bergquist Dr Ste 1 Lackland A F B, TX - 782369908 |
| Business Phone Number: | 2102925282 |
| Business Fax Number: | |
| Mailing Address: | 2200 Bergquist Dr Ste 1, LACKLAND A F B |
| State: | TX |
| Postal Code: | 782369908 |
| Phone Number: | 2102925282 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 286500000X |
| License Number: | E1250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Military Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care facility operated by the Department of Defense. |