Provider Demographics
NPI:1114927449
Name:RIEDERS, DANIEL EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWIN
Last Name:RIEDERS
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 1:5565 W LAS POSITAS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5805
Mailing Address - Country:US
Mailing Address - Phone:925-416-5460
Mailing Address - Fax:
Practice Address - Street 1:5565 W LAS POSITAS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5805
Practice Address - Country:US
Practice Address - Phone:925-416-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45077207R00000X, 207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72193OtherUNITED H'CARE PROV ID #
FL274946700Medicaid
FLP00283405OtherRAILROAD MEDICARE
FL3700333OtherCIGNA PROV ID #
FL11477OtherFIRST HEALTH PROV ID #
FL16520OtherBCBS OF FL PROV ID #
FL4131354OtherAETNA PROV ID #
FL3700333OtherCIGNA PROV ID #
A92547Medicare UPIN