Individual
JUSTIN DAVID SMALLRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN58541
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207026000
MEDICAID GROUP
WV
01
—
1417904848
MT STATE BLUE CROSS & BLUE SHIELD
WV
05
—
3810005046
—
WV
01
—
9333201
MEDICARE GROUP
WV
01
—
P00974070
MEDICARE RAILROAD
WV
Enumeration date
05/30/2006
Last updated
03/11/2025
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