Provider Demographics
NPI:1134221120
Name:RYDER, STEPHEN WOODBURY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WOODBURY
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 1:37210 GLENOAKS RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8534
Mailing Address - Country:US
Mailing Address - Phone:951-595-1381
Mailing Address - Fax:
Practice Address - Street 1:25240 HANCOCK AVE STE 120
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5991
Practice Address - Country:US
Practice Address - Phone:951-200-7800
Practice Address - Fax:951-973-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86956207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397735Medicaid
RY0700041Medicare ID - Type Unspecified
OH0397735Medicaid