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NPI Code Detail

MEDICARE: DR. BRENT G. RYDER PSY.D.

MEDICARE: DR. BRENT G. RYDER PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY0656NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PY0656OTHERNVLICENSE

General Provider Information

NPI Number : 1083860746
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENT G. RYDER PSY.D.
Provider Business Mailing Address
First Line : 500 N RAINBOW BLVD
Second Line : SUITE 300
City : LAS VEGAS
State : NV
Zip : 89107-1061
Country : US
Telephone Number : 702-350-3194
Fax Number : 702-221-1901
Provider Business Practice Location Address
First Line : 500 N RAINBOW BLVD
Second Line : SUITE 300
City : LAS VEGAS
State : NV
Zip : 89107-1061
Country : US
Telephone Number : 702-350-3194
Fax Number : 702-221-1901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 05/14/2014

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