Healthcare Provider Details

I. General information

NPI: 1477501054
Provider Name (Legal Business Name): DAVID JOSEPH RYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 E BELL RD STE. #143
PHOENIX AZ
85032-2236
US

IV. Provider business mailing address

4045 E BELL RD STE. #143
PHOENIX AZ
85032-2236
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-0404
  • Fax: 602-788-0893
Mailing address:
  • Phone: 602-867-0404
  • Fax: 602-788-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: