Healthcare Provider Details

I. General information

NPI: 1932818267
Provider Name (Legal Business Name): JOHN A. CRIST DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND AVE N STE 204
NAPLES FL
34102-5701
US

IV. Provider business mailing address

PO BOX 111324
NAPLES FL
34108-0123
US

V. Phone/Fax

Practice location:
  • Phone: 239-272-1185
  • Fax: 718-732-2063
Mailing address:
  • Phone: 239-272-1185
  • Fax: 239-732-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN A CRIST
Title or Position: CEO
Credential: DPM
Phone: 239-272-1185