Individual
DR. GERSON A CRISTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1390 HOPE DR, CARBONDALE, IL 62901-5306
(618) 351-4972
(618) 351-6522
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
Primary
036120557
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036120557
STATE LICENSE NUMBER
IL
05
—
036120557
—
IL
01
—
3932056
BCBS SIMS
IL
01
—
721089
AETNA GROUP
IL
01
—
P00785330
RAILROAD MEDICARE
MN
Enumeration date
07/30/2008
Last updated
05/21/2024
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