NPI 1083369938
Keaton James Rider
Practice location
- Address
- 104 W D.L. Ingram Ave, Cannon Afb, NM 88101
- Phone
- (575) 784-2778
- Mailing address
- 6948 Campos Ave Unit B, Jber, AK 99506-3423
Registered specialties
Independent Duty Medical Technicians
Primary
Registry record
- NPI
- 1083369938
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 18 Feb 2022
- Record last updated
- 2 Aug 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.