1487759296 NPI number — DEAN LOLLER RIDER MD

Table of content: DEAN LOLLER RIDER MD (NPI 1487759296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487759296 NPI number — DEAN LOLLER RIDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDER
Provider First Name:
DEAN
Provider Middle Name:
LOLLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487759296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 320670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-658-7497
Provider Business Mailing Address Fax Number:
415-929-1307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3580 CALIFORNIA STREET
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-658-7497
Provider Business Practice Location Address Fax Number:
415-929-1307
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  G401240 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 942983437 . This is a "BLUE CROSS PERS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "UNITE HEALTH CARE TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "BAY AREA AUTOMOTIVE WELFA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "UNITED HEALTHCARE TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9429834370001 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001800143 . This is a "BLUE SHIELD HIGHMARK OF P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "BLUE SHIELD OF CAL TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "BLUE CROSS OF CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5422000G401240 . This is a "BLUE SHIELD OF CAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "SF CULINARY BARTENDERS WE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "UNION LABOR LIFE INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G401240 . This is a "CARE ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013478 . This is a "HILL PHYSICIANS MED GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G401240 . This is a "MEDICAL CALIF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G401240 . This is a "HEALTH PLAN OF SAN MATEO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 600632 . This is a "BROWN AND TOLAND MED GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 942983437 . This is a "LIFE INVESTORS INS CO OF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G401240 . This is a "BLUE SHIELD OF CAL" identifier . This identifiers is of the category "OTHER".




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