Provider Demographics
NPI:1710111919
Name:CRIDDLE, CALVIN WAYNE JR
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:WAYNE
Last Name:CRIDDLE
Suffix:JR
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 1:18271 DUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-2527
Mailing Address - Country:US
Mailing Address - Phone:775-250-5367
Mailing Address - Fax:
Practice Address - Street 1:18271 DUSTIN CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89508-2527
Practice Address - Country:US
Practice Address - Phone:775-250-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist