Provider Demographics
NPI:1568999001
Name:CRISTEL, ROBERT TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:CRISTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 790379
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0379
Mailing Address - Country:US
Mailing Address - Phone:314-729-0077
Mailing Address - Fax:314-729-0101
Practice Address - Street 1:4651 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8690
Practice Address - Country:US
Practice Address - Phone:314-523-5300
Practice Address - Fax:314-434-3191
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022013289207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200109613Medicaid