Provider Demographics
NPI:1598146557
Name:CRIDER, COURTNEY CHAMPAGNE (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:CHAMPAGNE
Last Name:CRIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:RUE
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 BJC SAINT PETERS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3386
Mailing Address - Country:US
Mailing Address - Phone:636-916-8200
Mailing Address - Fax:636-946-5774
Practice Address - Street 1:201 BJC SAINT PETERS DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3386
Practice Address - Country:US
Practice Address - Phone:636-916-8200
Practice Address - Fax:636-946-5774
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019014137207N00000X
MO2015017799207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology