Individual
ABIGAIL CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1605 MARTIN SPRINGS DR, STE 210, ROLLA, MO 65401-2931
(573) 458-6326
(573) 458-6763
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012003234
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720347867
—
MO
01
—
431560263
TRICARE
MO
01
—
P01089883
RR MCR
MO
Enumeration date
05/10/2012
Last updated
12/20/2012
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