Provider Demographics
NPI:1720439607
Name:RYDER, MICHAEL PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:RYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 CARDIFF LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3679
Mailing Address - Country:US
Mailing Address - Phone:209-231-0808
Mailing Address - Fax:877-883-6503
Practice Address - Street 1:275 BLOMQUIST ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2718
Practice Address - Country:US
Practice Address - Phone:209-231-0808
Practice Address - Fax:877-883-6503
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01955207Q00000X
VA0116029717207Q00000X
CA21881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine