Individual
JARED MATTHEW CRIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6424 E BROADWAY RD STE 101, MESA, AZ 85206-1750
(480) 456-9000
Mailing address
2323 W ROSE GARDEN LN, PHOENIX, AZ 85027-2530
(602) 521-6252
(623) 842-5640
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2016-01281
NC
2085R0202X
Diagnostic Radiology Physician
Primary
54613
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343555
—
AZ
01
—
P01693581
RAILROAD MEDICARE
—
Enumeration date
05/26/2009
Last updated
05/29/2024
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