Provider Demographics
NPI:1972814176
Name:KRYDER, GEORGE DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DANIEL
Last Name:KRYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:400 US 70 HIGHWAY E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4049
Practice Address - Country:US
Practice Address - Phone:919-235-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN106776207R00000X
NC2024-00413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972814176OtherPRIME WEST HEALTHCARE
MN0066-0022220OtherMEDICA
MN1972814176OtherNPI
MN1972814176OtherBCBS
MN1972814176Medicaid
NC1972814176Medicaid
MN1972814176OtherHEALTH PARTNERS
MN1972814176OtherPREFERRED ONE
MN56608OtherMN LICENSE
MN1972814176OtherPREFERRED ONE