Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 042-0010840 | VT |
NPI | 1063436921 |
---|---|
Provider Name | Christopher J Ryder |
First Address | Springfield, VT 05156-2242 |
Second Address | Springfield, VT 05156-2242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010885 | (05) | VT |
G47156 | (02) | VT |