Healthcare Provider Details

I. General information

NPI: 1679097117
Provider Name (Legal Business Name): RYDER DOTY CPOA, CFO, CFTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ALVARADO DR SE
ALBUQUERQUE NM
87108-2940
US

IV. Provider business mailing address

124 ALVARADO DR SE
ALBUQUERQUE NM
87108-2940
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-1700
  • Fax:
Mailing address:
  • Phone: 818-521-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: