Healthcare Provider Details

I. General information

NPI: 1033435706
Provider Name (Legal Business Name): ALEX RYDER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 07/01/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 STATELINE RD E
SOUTHAVEN MS
38671-9486
US

IV. Provider business mailing address

9050 TELLURIDE CV
GERMANTOWN TN
38138-8400
US

V. Phone/Fax

Practice location:
  • Phone: 877-334-0021
  • Fax:
Mailing address:
  • Phone: 503-559-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number53551
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number53005
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number53551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: