Healthcare Provider Details

I. General information

NPI: 1396702882
Provider Name (Legal Business Name): CRAIG E. CRISMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 14TH AVE NE
WATERTOWN SD
57201-6811
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax: 605-884-4300
Mailing address:
  • Phone: 605-886-8482
  • Fax: 605-884-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3693
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: