Provider Demographics
NPI:1558899674
Name:RYDER, JONATHAN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HENRY
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 1:985400 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5209
Mailing Address - Country:US
Mailing Address - Phone:402-559-8367
Mailing Address - Fax:402-559-5581
Practice Address - Street 1:985400 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5400
Practice Address - Country:US
Practice Address - Phone:024-559-8367
Practice Address - Fax:402-559-5581
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11019309A390200000X
NE34426207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program