Provider Demographics
NPI:1093585473
Name:STRIDER, BRIAN C
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:STRIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24130 BRADFORD GREEN SQ
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9221
Mailing Address - Country:US
Mailing Address - Phone:434-996-1105
Mailing Address - Fax:
Practice Address - Street 1:24130 BRADFORD GREEN SQ
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9221
Practice Address - Country:US
Practice Address - Phone:434-996-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCSTRI-R94FL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner