# ABIGAIL CRISOSTOMO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1720347867
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2012003234 | MO | Yes |

## Other

- **Enumeration date:** 05/10/2012
- **Last updated:** 12/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1720347867 | — | MO |
| 01 | — | 431560263 | TRICARE | MO |
| 01 | — | P01089883 | RR MCR | MO |