Provider Demographics
NPI:1154640993
Name:RIDER, JAMES ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-1206
Mailing Address - Country:US
Mailing Address - Phone:830-379-7901
Mailing Address - Fax:830-401-0737
Practice Address - Street 1:1414 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5175
Practice Address - Country:US
Practice Address - Phone:830-379-7901
Practice Address - Fax:830-401-0737
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311428201Medicaid
TX8DM981OtherBCBS
TX8DM981OtherBCBS