Individual
JACOB JAMES RIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
1768
NE
363AM0700X
Medical Physician Assistant
002439
IA
363AM0700X
Medical Physician Assistant
Primary
1768
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026411700
—
NE
05
—
1841673738
—
IA
Enumeration date
09/06/2013
Last updated
07/21/2022
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