Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 05-17984 | KS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2420 | KS |
NPI | 1215968870 |
---|---|
Provider Name | James V Rider |
First Address | Valley Falls, KS 66088-1289 |
Second Address | Winchester, KS 66097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2429680706 | (05) | KS |
D78645 | (02) | KS |