Provider Demographics
NPI:1467456178
Name:GOVEIA, CRYSTAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:R
Last Name:GOVEIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 WATERVILLE MONCLOVA RD
Mailing Address - Street 2:STE A
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1169
Mailing Address - Country:US
Mailing Address - Phone:419-878-2026
Mailing Address - Fax:419-878-3236
Practice Address - Street 1:900 WATERVILLE MONCLOVA RD
Practice Address - Street 2:STE A
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1169
Practice Address - Country:US
Practice Address - Phone:419-878-2026
Practice Address - Fax:419-878-3236
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35100102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine