Individual
DR. ROBERT W RYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 964-1251
Mailing address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 964-1251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36079
MA
207RI0200X
Infectious Disease Physician
36079
MA
207RI0200X
Infectious Disease Physician
Primary
G88178
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1813
MEDICARE ID
CA
05
—
FHC03967F
—
CA
Enumeration date
11/16/2006
Last updated
10/28/2014
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