Provider Demographics
NPI:1487648770
Name:CRICK, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 KENNERLY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4368
Mailing Address - Country:US
Mailing Address - Phone:904-739-0050
Mailing Address - Fax:904-443-2888
Practice Address - Street 1:6100 KENNERLY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4368
Practice Address - Country:US
Practice Address - Phone:904-739-0050
Practice Address - Fax:904-443-2888
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2015-02-19
Deactivation Date:2006-04-13
Deactivation Code:
Reactivation Date:2006-04-19
Provider Licenses
StateLicense IDTaxonomies
FLME29382207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00473370OtherRAILROAD MEDICARE
FL15627OtherBCBS
FL4007101004OtherCIGNA
FL211397OtherAVMED
FL4045147OtherAETNA
FL211397OtherAVMED