Basic Information
| Provider Information | |||||||||
| NPI: | 1316278674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRISSMAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | WARD | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4311 SALISBURY RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043324300 | ||||||||
| FaxNumber: | 9073324339 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 CAPITAL MEDICAL BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503254242 | ||||||||
| FaxNumber: | 9043324339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2010 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9105322 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.