Individual
DR. BRAXTON HARRIS RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
1 AUDUBON PLAZA DR, LOUISVILLE, KY 40217-1318
(502) 636-7111
Mailing address
946 GOSS AVE APT 1111, LOUISVILLE, KY 40217-1200
Taxonomy
Speciality
Code
Description
License number
State
211D00000X
Podiatric Assistant
284367
KY
213E00000X
Podiatrist
Primary
284367
KY
213EP0504X
Public Medicine Podiatrist
284367
KY
213EP1101X
Primary Podiatric Medicine Podiatrist
284367
KY
213ER0200X
Radiology Podiatrist
284367
KY
213ES0000X
Sports Medicine Podiatrist
284367
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
284367
KY
213ES0131X
Foot Surgery Podiatrist
284367
KY
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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