Provider Demographics
NPI:1275596843
Name:RIDER, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:RIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EAST TWOHIG
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903
Mailing Address - Country:US
Mailing Address - Phone:325-340-9899
Mailing Address - Fax:
Practice Address - Street 1:2141 HAMILTON WAY
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6433
Practice Address - Country:US
Practice Address - Phone:325-245-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1648OtherBLUE CROSS
TX128594207Medicaid
TX8K1648OtherBLUE CROSS
TXB25917Medicare UPIN