Ken Eugene Crider, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

79-151 Issued in NM

Practice address

622 W Maple St
Suite B
Farmington, NM 87401-6590

Phone

(505) 327-4867

Fax

(505) 327-5355

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204848000000",
    "number": "1831114172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016590",
            "telephone_number": "505-327-4867",
            "fax_number": "505-327-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016590",
            "telephone_number": "505-327-4867",
            "fax_number": "505-327-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRIDER",
        "first_name": "KEN",
        "middle_name": "EUGENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "79-151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11072",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Farmington, NM
• Providers in Farmington, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.