MEDICARE: LUZ T. CRYSTAL M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	18535	AL

General Provider Information

NPI Number	:	1417198946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUZ T. CRYSTAL M.D., P.C.

Provider Business Mailing Address
First Line	:	2202 JORDAN RD SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3688
Country	:	US
Telephone Number	:	256-844-2825
Fax Number	:	256-845-1804

Provider Business Practice Location Address
First Line	:	2202 JORDAN RD SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3688
Country	:	US
Telephone Number	:	256-844-2825
Fax Number	:	256-845-1804

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUZ TORRALBA CRYSTAL
Credential	:	M.D.
Telephone Number	:	256-844-2825

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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