Healthcare Provider Details

I. General information

NPI: 1528086642
Provider Name (Legal Business Name): JOHN BENTON CRIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N MAIN ST
ARAB AL
35016-1070
US

IV. Provider business mailing address

1170 N MAIN ST
ARAB AL
35016-1070
US

V. Phone/Fax

Practice location:
  • Phone: 256-586-4127
  • Fax: 256-586-0535
Mailing address:
  • Phone: 256-586-4127
  • Fax: 256-586-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14729
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: