Healthcare Provider Details

I. General information

NPI: 1205857331
Provider Name (Legal Business Name): AMANDA G RYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 40TH AVE
YAKIMA WA
98908-4311
US

IV. Provider business mailing address

PO BOX 2947
YAKIMA WA
98907-2947
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-9480
  • Fax: 509-966-3283
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-249-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00036727
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: