Healthcare Provider Details

I. General information

NPI: 1902739626
Provider Name (Legal Business Name): CRYSTAL MCVAY PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E 23RD ST STE E
PANAMA CITY FL
32405-4556
US

IV. Provider business mailing address

217 E 23RD ST STE E
PANAMA CITY FL
32405-4556
US

V. Phone/Fax

Practice location:
  • Phone: 850-630-6155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL MCVAY
Title or Position: APRN
Credential: APRN
Phone: 850-630-6155