Individual
DR. RODERIC CLAYTON CRIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3095 LEXINGTON AVE, SUITE 200, CAPE GIRARDEAU, MO 63701-2602
(573) 339-0004
Mailing address
3095 LEXINGTON AVE, SUITE 200, CAPE GIRARDEAU, MO 63701-2602
(573) 339-0004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R2H52
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080192016
RAILROAD MEDICARE
MO
01
—
820571426
TRICARE
MO
Enumeration date
01/28/2006
Last updated
08/11/2011
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