MEDICARE: DAVID R RIKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	34683	IA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	34683	IA
3	207RP1001X	Pulmonary Disease Physician	34683	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	39633	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1164405528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R RIKER MD

Provider Business Mailing Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	617-939-6943
Fax Number	:	858-822-5338

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	617-939-6943
Fax Number	:	858-822-5338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	01/15/2013

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Directions to “ DAVID R RIKER MD” Practice Location

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