Provider Demographics
NPI:1396914206
Name:STEVEN R. CRIDER, M.D., APMC
Entity type:Organization
Organization Name:STEVEN R. CRIDER, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:REID
Authorized Official - Last Name:CRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-329-8410
Mailing Address - Street 1:405 STELLA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2968
Mailing Address - Country:US
Mailing Address - Phone:318-807-8410
Mailing Address - Fax:318-807-8411
Practice Address - Street 1:405 STELLA ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2968
Practice Address - Country:US
Practice Address - Phone:318-807-8410
Practice Address - Fax:318-807-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 14000R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DD20Medicare PIN