Individual
MR. JERRY RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1650 COCHRANE CIR, FORT CARSON, CO 80913-4613
(719) 526-2361
Mailing address
10TH MEDICAL GROUP/SGHC, 4102 PINION DR, AIR FORCE ACADEMY, CO 80840
(719) 684-3159
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2594
TN
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
2594
TN
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/06/2006
Last updated
06/13/2024
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