Crisco, Larry Van Thomas
Crisco, Larry Van Thomas is an individual health care provider with primary practice located at 3901 University Blvd S Suite 221, Jacksonville FL 32216-4392. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Nuclear Cardiology, Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Crisco, Larry Van Thomas can be contacted via phone (904) 423-0010.Contact Information
Primary practice address
3901 University Blvd S Suite 221
Jacksonville FL 32216-4392
Phone: (904) 423-0010
Fax: (904) 423-0012
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 038457 | Georgia |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | ME115672 | Florida |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 38457 | Georgia |
| Allopathic & Osteopathic Physicians / Nuclear Cardiology | 207UN0901X | 38457 | Georgia |
| Allopathic & Osteopathic Physicians / Nuclear Imaging & Therapy | 207UN0902X | 38457 | Georgia |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | ME115672 | Florida |
Profile Details
| NPI number | 1952395782 |
|---|---|
| LBN Legal business name | Crisco, Larry Van Thomas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 8th, 2005 |
| Last updated | Aug 30th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952395782 | NPPES |
| Georgia | MEDICAID | 000777686G | |
| Georgia | Other | 58-1624987 | |
| Georgia | Other | 1952395782 |
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