Individual
DR. MATHEW GLEN KRISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4126 WEST MAIN STREET, DOTHAN, AL 36305-9310
(334) 793-2120
(334) 671-0228
Mailing address
PO BOX 6599, DOTHAN, AL 36302-6599
(334) 793-2120
(334) 671-0228
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21833
AL
207P00000X
Emergency Medicine Physician
32247
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000799664B
—
GA
05
—
051515842
—
AL
05
—
06009894
—
MS
05
—
1756539
—
LA
05
—
255415100
—
FL
01
—
51515842
BC BS OF AL
AL
01
—
P00055578
RAILROAD MEDICARE
—
Enumeration date
04/12/2006
Last updated
09/23/2020
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