Provider Demographics
NPI:1194709550
Name:CRISOLOGO, PETER ALBERT (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ALBERT
Last Name:CRISOLOGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2151 OLD ROCKY RIDGE ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7251
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:1912 ALABAMA HWY 157
Practice Address - Street 2:CULLMAN REGIONAL MEDICAL CENTER
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0000
Practice Address - Country:US
Practice Address - Phone:256-737-2637
Practice Address - Fax:256-734-6257
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.14016207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2777OtherHEALTHSPRING OF ALABAMA
051086833OtherBLUE CROSS BLUE SHIELD
AL000086833Medicaid
2777OtherHEALTH STRATEGIES INC
631003288OtherTRICARE (GROUP)
2777OtherHEALTH STRATEGIES INC
AL051586833Medicare ID - Type Unspecified