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General NPI Number Information
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NPI Number | 1477810885
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Entity Type | Individual
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Provider Name | NATHANIEL JAMES CRIDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 4534 W GATE BLVD
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City | AUSTIN
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State | TX
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Zip | 78745-1485
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Country | US
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Telephone | 312-635-0973
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Fax | 312-635-0500
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Provider Business Mailing Address
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Address Line | PO BOX 74008272
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City | CHICAGO
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State | IL
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Zip | 60674-8272
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Country | US
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Telephone | 312-635-0973
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Fax | 702-977-1496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 60417
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 192126
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 60417
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License Number State | MN
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