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General NPI Number Information
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NPI Number | 1972750446
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Entity Type | Individual
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Provider Name | STACEY MACIP RYDER MD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 4801 AMBASSADOR CAFFERY PKWY
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City | LAFAYETTE
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State | LA
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Zip | 70508-6917
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Country | US
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Telephone | 337-470-2180
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Fax | 337-470-2677
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Provider Business Mailing Address
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Address Line | 1888 HUDSON CIR STE 2
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City | MONROE
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State | LA
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Zip | 71201-3547
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Country | US
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Telephone | 337-470-2180
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Fax | 337-470-2677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD.205841
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License Number State | LA
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