Healthcare Provider Details

I. General information

NPI: 1760417885
Provider Name (Legal Business Name): ANJA CRIDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 336TH ST
FEDERAL WAY WA
98003-6311
US

IV. Provider business mailing address

900 S 336TH ST
FEDERAL WAY WA
98003-6311
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-0610
  • Fax: 253-237-0606
Mailing address:
  • Phone: 253-237-0610
  • Fax: 253-237-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00033511
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: