Healthcare Provider Details

I. General information

NPI: 1700889383
Provider Name (Legal Business Name): CHARLES J CRIST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 DR MARTIN LUTHER KING ST N
ST PETERSBURG FL
33704-2034
US

IV. Provider business mailing address

PO BOX 1830
CLEARWATER FL
33757-1830
US

V. Phone/Fax

Practice location:
  • Phone: 727-822-3238
  • Fax: 727-823-1278
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-532-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME9468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: