Individual
DR. CHARLES TRAVIS CRIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3277 E LOUISE DR, SUITE 200, MERIDIAN, ID 83642-9351
(208) 468-5930
(208) 463-3044
Mailing address
217 W GEORGIA AVE, SUITE 115, NAMPA, ID 83686-6811
(208) 463-3234
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125-051457
IL
208000000X
Pediatrics Physician
Primary
O-0532
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8084089
—
ID
Enumeration date
06/13/2007
Last updated
12/18/2009
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