Provider Demographics
NPI:1437482171
Name:BUJOLD, CRYSTAL ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANNE
Last Name:BUJOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 MEDICAL CENTER DR STE 209
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1602
Mailing Address - Country:US
Mailing Address - Phone:469-440-2570
Mailing Address - Fax:214-548-5667
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-440-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2207207R00000X
FLOS 11694207RC0000X
TXR3480207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH039ZOtherMEDICARE NUMBER