Provider Demographics
NPI:1487759296
Name:RIDER, DEAN LOLLER (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:LOLLER
Last Name:RIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320670
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132
Mailing Address - Country:US
Mailing Address - Phone:415-658-7497
Mailing Address - Fax:415-929-1307
Practice Address - Street 1:3580 CALIFORNIA STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1725
Practice Address - Country:US
Practice Address - Phone:415-658-7497
Practice Address - Fax:415-929-1307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILG401240207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
942983437OtherBLUE CROSS PERS CARE
942983437OtherUNITE HEALTH CARE TAX ID
942983437OtherBAY AREA AUTOMOTIVE WELFA
942983437OtherUNITED HEALTHCARE TAX ID
9429834370001OtherCIGNA HEALTHCARE
001800143OtherBLUE SHIELD HIGHMARK OF P
942983437OtherBLUE SHIELD OF CAL TAX ID
942983437OtherBLUE CROSS OF CA
5422000G401240OtherBLUE SHIELD OF CAL
942983437OtherSF CULINARY BARTENDERS WE
942983437OtherUNION LABOR LIFE INS
00G401240OtherCARE ADVANTAGE
013478OtherHILL PHYSICIANS MED GRP
00G401240OtherMEDICAL CALIF
00G401240OtherHEALTH PLAN OF SAN MATEO
600632OtherBROWN AND TOLAND MED GRP
942983437OtherLIFE INVESTORS INS CO OF
00G401240OtherBLUE SHIELD OF CAL
942983437OtherUNITE HEALTH CARE TAX ID
942983437OtherUNITE HEALTH CARE TAX ID