MEDICARE: RONALD REIDER 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	207R00000X	Internal Medicine Physician	21089	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00731348	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386623163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD REIDER MD

Provider Business Mailing Address
First Line	:	1026 A AVENUE
Second Line	:	SUITE 5000
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3026
Country	:	US
Telephone Number	:	319-368-5976
Fax Number	:	319-368-5932

Provider Business Practice Location Address
First Line	:	1026 A AVENUE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3026
Country	:	US
Telephone Number	:	319-369-7393
Fax Number	:	319-369-8351

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	10/19/2009

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