Individual
LADDIE CRISP III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL PARK BLVD STE 255W, BRISTOL, TN 37620-7430
(276) 378-2026
Mailing address
509 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-2579
(423) 302-6567
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MRM-1726
ID
208M00000X
Hospitalist Physician
0101272131
VA
208M00000X
Hospitalist Physician
Primary
63278
TN
Other
Enumeration date
05/15/2018
Last updated
09/28/2022
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