Provider Demographics
NPI:1174675409
Name:CRIST, JOHN A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CRIST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1130 CREEKSIDE PKWY
Mailing Address - Street 2:BOX 111324
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1153
Mailing Address - Country:US
Mailing Address - Phone:239-272-1185
Mailing Address - Fax:718-732-2063
Practice Address - Street 1:1443 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3206
Practice Address - Country:US
Practice Address - Phone:863-686-6200
Practice Address - Fax:813-752-0093
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO 1768213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201805OtherSTAYWELL PIN
FL480012416OtherRAILROAD MEDICARE
FL593105185OtherTAX ID
FL480012416OtherRAILROAD MEDICARE
FLT55639Medicare UPIN