MEDICARE: DUANE R. CRIST M.D.

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	207P00000X	Emergency Medicine Physician	9232865	UT
2	207P00000X	Emergency Medicine Physician	22536	AZ

General Provider Information

NPI Number	:	1740217264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE R. CRIST M.D.

Provider Business Mailing Address
First Line	:	275 S RED ROCK ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1955
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37000 N GANTZEL RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7303
Country	:	US
Telephone Number	:	480-394-4000
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	12/15/2021

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Directions to “ DUANE R. CRIST M.D.” Practice Location

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