Provider Demographics
NPI:1568557437
Name:REIDER, DANER R (MD)
Entity Type:Individual
Prefix:
First Name:DANER
Middle Name:R
Last Name:REIDER
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 1:14681 RAINTREE LANE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-832-8177
Mailing Address - Fax:
Practice Address - Street 1:14681 RAINTREE LN
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7123
Practice Address - Country:US
Practice Address - Phone:714-293-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG218842083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE787BMedicare PIN
CACE900WMedicare UPIN
CACE900UMedicare UPIN
CACE900SMedicare UPIN
CACE900ZMedicare UPIN
CACE787FMedicare PIN
CACE787DMedicare PIN
CACE900YMedicare UPIN
CAZZZ07334ZMedicare PIN
CACE900XMedicare UPIN
CACE787EMedicare PIN
CACE900VMedicare UPIN
CACE900TMedicare UPIN
CACE787GMedicare PIN
CACE787CMedicare PIN
CACE787AMedicare PIN