Provider Demographics
NPI:1851457444
Name:CRISS, JONATHAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:CRISS
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 1:1717 W WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6319
Mailing Address - Country:US
Mailing Address - Phone:561-737-5500
Mailing Address - Fax:561-737-7055
Practice Address - Street 1:1717 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6319
Practice Address - Country:US
Practice Address - Phone:561-737-5500
Practice Address - Fax:561-737-7055
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101208207W00000X
NY257187207W00000X
FLME 118571207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology