Dr. Ryder Lane Costa, DO
Internal Medicine in Corinth, MS. Individual provider (NPI-1).
NPI number1053005751
StatusActive
Last updated in NPPESJun 7, 2023
Details
- NPI
- 1053005751
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ryder Lane Costa
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 6, 2023
- Certification date
- Jun 7, 2023
- Last updated
- Jun 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | COST-GQ4B33 | MS | Yes |
Practice location
611 Alcorn DrCorinth, MS 38834-9388
Phone 662-293-1143
Mailing address
611 Alcorn DrCorinth, MS 38834-9388
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