Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | PA2008-022 | NM |
NPI | 1033371307 |
---|---|
Provider Name | Jessica Chloe Ryder |
First Address | Albuquerque, NM 87109-1246 |
Second Address | Albuquerque, NM 87109-1246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 25/08/2020 |