Provider Demographics
NPI:1326256967
Name:CRIDDLE, MICHAEL WEBSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WEBSTER
Last Name:CRIDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6200 MANTANO PLZ DR NW APT 711
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5760
Mailing Address - Country:US
Mailing Address - Phone:505-999-0321
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 4600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4925
Practice Address - Country:US
Practice Address - Phone:505-563-6450
Practice Address - Fax:505-563-6484
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology