Healthcare Provider Details

I. General information

NPI: 1255460135
Provider Name (Legal Business Name): THOMAS RICHARD RYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MONTCLAIR RD SUITE 570
BIRMINGHAM AL
35213-1972
US

IV. Provider business mailing address

880 MONTCLAIR RD SUITE 570
BIRMINGHAM AL
35213-1972
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-7246
  • Fax: 205-591-4420
Mailing address:
  • Phone: 205-591-7246
  • Fax: 205-591-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number00012527
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: