Provider Demographics
NPI:1417198946
Name:LUZ T. CRYSTAL M.D., P.C.
Entity Type:Organization
Organization Name:LUZ T. CRYSTAL M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:TORRALBA
Authorized Official - Last Name:CRYSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-844-2825
Mailing Address - Street 1:2202 JORDAN RD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3688
Mailing Address - Country:US
Mailing Address - Phone:256-844-2825
Mailing Address - Fax:256-845-1804
Practice Address - Street 1:2202 JORDAN RD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3688
Practice Address - Country:US
Practice Address - Phone:256-844-2825
Practice Address - Fax:256-845-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty