Individual
KEN EUGENE CRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
622 W MAPLE ST, SUITE B, FARMINGTON, NM 87401-6590
(505) 327-4867
(505) 327-5355
Mailing address
622 W MAPLE ST, SUITE B, FARMINGTON, NM 87401-6590
(505) 327-4867
(505) 327-5355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
79-151
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11072
—
NM
Enumeration date
07/13/2006
Last updated
03/07/2008
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