Provider Demographics
NPI:1326202185
Name:RIDER, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:RIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:M
Other - Last Name:MARTIN RIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
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 EAST WALNUT
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-379-7901
Practice Address - Fax:830-401-0737
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076SKOtherBLUE CROSS / BLUE SHIELD ID #
P00829322OtherMEDICARE RAILROAD PROVIDER PTAN
TX2089773-01Medicaid
TX2089773-01Medicaid