Provider Demographics
NPI:1477501054
Name:RYDER, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:RYDER
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 1:4045 E BELL RD
Mailing Address - Street 2:STE. #143
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-867-0404
Mailing Address - Fax:602-788-0893
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:STE. #143
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-867-0404
Practice Address - Fax:602-788-0893
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ190802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7050OtherHEALTH NET
AZ146086Medicaid
AZAZ0345920OtherBLUE CROSS BLUE SHIELD
AZ146086Medicaid
AZWCKNS05Medicare ID - Type Unspecified