Provider Demographics
NPI:1194723718
Name:MCCRYSTAL, HUGH KEARNS (MD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:KEARNS
Last Name:MCCRYSTAL
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 1:787 37TH ST
Mailing Address - Street 2:SUITE E200
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-567-3003
Mailing Address - Fax:772-567-2926
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E200
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-567-3003
Practice Address - Fax:772-567-2926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 10579208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54188Medicare UPIN
FL39249Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
FL310422ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBR