Healthcare Provider Details

I. General information

NPI: 1063403558
Provider Name (Legal Business Name): ALAN SCOTT KRIMSLEY M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W MIDWAY RD
FORT PIERCE FL
34982-4201
US

IV. Provider business mailing address

4400 COUNTRY CLUB DR
DICKINSON TX
77539-7620
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-3222
  • Fax: 772-460-7927
Mailing address:
  • Phone: 281-337-3423
  • Fax: 281-337-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME0042865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: