MEDICARE: DR. STACEY MACIP 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
1	2085R0202X	Diagnostic Radiology Physician	MD.205841	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1972750446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY MACIP RYDER MD

Provider Business Mailing Address
First Line	:	1888 HUDSON CIR STE 2
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-3547
Country	:	US
Telephone Number	:	337-470-2180
Fax Number	:	337-470-2677

Provider Business Practice Location Address
First Line	:	4801 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6917
Country	:	US
Telephone Number	:	337-470-2180
Fax Number	:	337-470-2677

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	12/11/2025

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