MEDICARE: DR. JANE RIDER 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
1	208000000X	Pediatrics Physician	G1250	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8K1648	OTHER	TX	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275596843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE RIDER MD

Provider Business Mailing Address
First Line	:	12 EAST TWOHIG
Second Line	:	STE. 200
City	:	SAN ANGELO
State	:	TX
Zip	:	76903
Country	:	US
Telephone Number	:	325-340-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 HAMILTON WAY
Second Line	:	STE. 100
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6433
Country	:	US
Telephone Number	:	325-245-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	09/10/2012

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Directions to “ DR. JANE RIDER MD” Practice Location

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