Provider Demographics
NPI:1437579026
Name:CRISSMAN, AMY LORIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LORIN
Last Name:CRISSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7104
Mailing Address - Country:US
Mailing Address - Phone:713-486-1200
Mailing Address - Fax:
Practice Address - Street 1:8810 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7104
Practice Address - Country:US
Practice Address - Phone:713-486-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR2560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
R2560OtherTX LICENSE NUMBER
TX1437579026OtherNPI
TX371192103OtherTPI NUMBER