=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063403558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN SCOTT KRIMSLEY M.D.,
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 604 W MIDWAY RD
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34982-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-468-3222
-----------------------------------------------------
Fax | 772-460-7927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4400 COUNTRY CLUB DR
-----------------------------------------------------
City | DICKINSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77539-7620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-337-3423
-----------------------------------------------------
Fax | 281-337-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | ME0042865
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------