Individual
DR. KEVIN DANIEL CRISMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8773 PERIMETER PARK CT, JACKSONVILLE, FL 32216-1165
(904) 493-3390
(904) 493-3395
Mailing address
8773 PERIMETER PARK CT, JACKSONVILLE, FL 32216-1165
(904) 493-3390
(904) 493-3395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS7896
FL
208M00000X
Hospitalist Physician
Primary
OS7896
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003174436A
GEORGIA MEDICAID
GA
01
—
110220060
RR MEDICARE
FL
01
—
152348
WELLCARE
FL
01
—
2568802-00
MEDICAID - INDIVIDUAL
FL
01
—
2610299-00
MEDICAID - GROUP
FL
01
—
264319
AVMED
FL
01
—
45681
MEDICARE - GROUP
FL
01
—
47222
FLORIDA BLUE
FL
01
—
E2746Y
MEDICARE - INDIVIDUAL
FL
Enumeration date
06/22/2005
Last updated
08/04/2016
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