Provider Demographics
NPI:1679869168
Name:RIDER, BLAINE EMANUEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:EMANUEL
Last Name:RIDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1610 LEAFHOPPER LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-5306
Mailing Address - Country:US
Mailing Address - Phone:337-322-4753
Mailing Address - Fax:
Practice Address - Street 1:808 RUSSELL PALMER RD
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1689
Practice Address - Country:US
Practice Address - Phone:281-540-0685
Practice Address - Fax:281-540-0684
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP120948367500000X
MO087222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered