Healthcare Provider Details

I. General information

NPI: 1902058969
Provider Name (Legal Business Name): JOHN B CRIDER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
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: JOHN B CRIDER
Title or Position: OWNER
Credential: MD
Phone: 256-586-4127