Provider Demographics
NPI:1346223229
Name:CRISS, CATHY L (DO)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:CRISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:19531 COCHRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2081
Practice Address - Country:US
Practice Address - Phone:941-255-3535
Practice Address - Fax:941-766-7999
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0007162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA77406Medicare UPIN
FL57344XMedicare PIN