Basic Information
| Provider Information | |||||||||
| NPI: | 1780252320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 PEBRICAN AVE | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820014724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068582791 | ||||||||
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| Practice Location | |||||||||
| Address1: | 821 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820014775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077777911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 197-T1 | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.