Provider Demographics
NPI:1134192289
Name:CRITTENDEN, JOSEPH JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAY
Last Name:CRITTENDEN
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 1:8909 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5610
Mailing Address - Country:US
Mailing Address - Phone:850-477-2662
Mailing Address - Fax:850-473-8225
Practice Address - Street 1:8909 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5610
Practice Address - Country:US
Practice Address - Phone:850-477-2662
Practice Address - Fax:850-473-8225
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000150482085R0202X
FLME149862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D53187Medicare UPIN