Provider Demographics
NPI:1063403558
Name:KRIMSLEY, ALAN SCOTT (MD,)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:KRIMSLEY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7620
Mailing Address - Country:US
Mailing Address - Phone:281-337-3423
Mailing Address - Fax:281-337-2611
Practice Address - Street 1:604 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-4201
Practice Address - Country:US
Practice Address - Phone:772-468-3222
Practice Address - Fax:772-460-7927
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00428652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56169OtherBCBS
D65164Medicare UPIN
FL56169WMedicare ID - Type Unspecified