Healthcare Provider Details

I. General information

NPI: 1487648770
Provider Name (Legal Business Name): JOHN C CRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date: 04/13/2006
Reactivation Date: 04/19/2006

III. Provider practice location address

6100 KENNERLY RD SUITE 101
JACKSONVILLE FL
32216-4368
US

IV. Provider business mailing address

6100 KENNERLY RD SUITE 101
JACKSONVILLE FL
32216-4368
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0050
  • Fax: 904-443-2888
Mailing address:
  • Phone: 904-739-0050
  • Fax: 904-443-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME29382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: