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NPI Code Detail

MEDICARE: AMANDA G RYDER MD

MEDICARE: AMANDA G RYDER MD
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
1207Q00000XFamily Medicine PhysicianMD00036727WA

General Provider Information

NPI Number : 1205857331
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA G RYDER MD
Provider Business Mailing Address
First Line : PO BOX 2947
Second Line :
City : YAKIMA
State : WA
Zip : 98907-2947
Country : US
Telephone Number : 509-248-7849
Fax Number : 509-249-5042
Provider Business Practice Location Address
First Line : 504 N 40TH AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98908-4311
Country : US
Telephone Number : 509-966-9480
Fax Number : 509-966-3283
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 07/08/2007

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