Provider Demographics
NPI:1477810885
Name:CRIDER, NATHANIEL JAMES (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JAMES
Last Name:CRIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74008272
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8272
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:702-977-1496
Practice Address - Street 1:4534 W GATE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1485
Practice Address - Country:US
Practice Address - Phone:312-635-0973
Practice Address - Fax:312-635-0500
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60417208D00000X, 208100000X
NC192126208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice