Individual
KEATON JAMES RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 W D.L. INGRAM AVE, CANNON AFB, NM 88101
(575) 784-2778
Mailing address
6948 CAMPOS AVE UNIT B, JBER, AK 99506-3423
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
L5ALJ4N051C00AB
TX
Other
Enumeration date
02/18/2022
Last updated
08/02/2022
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