Individual
BLAINE S. KRISTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1348 S 18TH ST STE 230, FERNANDINA BEACH, FL 32034-4785
(904) 277-2003
(904) 376-3271
Mailing address
PO BOX 746643, ATLANTA, GA 30374-6643
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
MD-13190
HI
208800000X
Urology Physician
Primary
ME159017
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000253955
HMSA BILLING NUMBER
HI
05
—
118728900
—
FL
05
—
572702-01
—
HI
Enumeration date
09/22/2006
Last updated
11/04/2025
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