Provider Demographics
NPI:1215968870
Name:RIDER, JAMES V (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:RIDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 ELM ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66088-1289
Mailing Address - Country:US
Mailing Address - Phone:785-945-6894
Mailing Address - Fax:785-945-3902
Practice Address - Street 1:4TH AND WINCHESTER
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097
Practice Address - Country:US
Practice Address - Phone:913-774-2150
Practice Address - Fax:913-774-2308
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-17984207Q00000X
KS2420207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2429680706Medicaid
KS2429680706Medicaid
KS103108Medicare ID - Type UnspecifiedWMC