MEDICARE: CHRISTOPHER ROBIN CROMWELL MD

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	208200000X	Plastic Surgery Physician	106293	FL
2	2086S0122X	Plastic and Reconstructive Surgery Physician	200401193	NC
3	2086S0122X	Plastic and Reconstructive Surgery Physician	ME106293	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	138JW	OTHER	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629073382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ROBIN CROMWELL MD

Provider Business Mailing Address
First Line	:	293 NW PEACOCK BLVD STE 201
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2222
Country	:	US
Telephone Number	:	772-204-8870
Fax Number	:	772-204-8873

Provider Business Practice Location Address
First Line	:	293 NW PEACOCK BLVD STE 201
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2222
Country	:	US
Telephone Number	:	772-204-8870
Fax Number	:	772-204-8873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/07/2023

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Directions to “ CHRISTOPHER ROBIN CROMWELL MD” Practice Location

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