Basic Information
| Provider Information | |||||||||
| NPI: | 1033371307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYDER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | CHLOE | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871091246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE STE 102 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871091246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | PA2008-022 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.