Individual
LARRY VAN THOMAS CRISCO
Active
Individual
LARRY VAN THOMAS CRISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
038457
GA
207RC0000X
Cardiovascular Disease Physician
ME115672
FL
207RI0011X
Interventional Cardiology Physician
38457
GA
207RI0011X
Interventional Cardiology Physician
Primary
ME115672
FL
207UN0901X
Nuclear Cardiology Physician
38457
GA
207UN0902X
Nuclear Imaging & Therapy Physician
38457
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000777686G
—
GA
01
—
1952395782
NPI
—
01
—
58-1624987
TAX ID#
GA
Enumeration date
09/08/2005
Last updated
08/30/2019
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