Individual
SCOTT J CRYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
819 STATE ROUTE 664 N, LOGAN, OH 43138
(740) 380-8140
(740) 380-8150
Mailing address
PO BOX 228, LOGAN, OH 43138-0228
(740) 380-4181
(740) 385-0865
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50002332
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000547134
ANTHEM
OH
05
—
2330150
—
OH
01
—
2553018
UHC
OH
Enumeration date
10/18/2006
Last updated
02/01/2021
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