Provider Demographics
NPI:1659616670
Name:RIDER, MONICA RAQUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RAQUEL
Last Name:RIDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RAQUEL
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-405-3924
Practice Address - Street 1:2103 N ROME AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3509
Practice Address - Country:US
Practice Address - Phone:813-490-1426
Practice Address - Fax:813-490-1760
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2611207Q00000X
FLOS12222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine