Organization
CRYSTAL COMMUNITY E N T
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY SURRENCY (OFFICE MANAGER)
(352) 795-0011
Entity
Organization
Contact information
Practice address
790 SE 5TH TER, CRYSTAL RIVER, FL 34429-4852
(352) 795-0011
(352) 795-9481
Mailing address
790 SE 5TH TER, CRYSTAL RIVER, FL 34429-4852
(352) 795-0011
(352) 795-9481
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
OS5716
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1409549
UNITED MINE WORKERS
FL
01
—
200691
AVMED
FL
01
—
80221
BCBS OF FLORIDA
FL
01
—
DA5520
RAILROAD MCR GROUP#
FL
01
—
P00062969
RAILROAD MEDICARE
FL
Enumeration date
03/27/2007
Last updated
09/11/2018
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