Healthcare Provider Details

I. General information

NPI: 1609996198
Provider Name (Legal Business Name): JAMES E. RYDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SLIGH BLVD
ORLANDO FL
32806-1108
US

IV. Provider business mailing address

1220 SLIGH BLVD
ORLANDO FL
32806-1108
US

V. Phone/Fax

Practice location:
  • Phone: 407-210-4251
  • Fax: 407-648-0968
Mailing address:
  • Phone: 407-210-4251
  • Fax: 407-648-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA91000685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: