Provider Demographics
NPI:1891821211
Name:CRIMI, ETTORE (MD)
Entity type:Individual
Prefix:
First Name:ETTORE
Middle Name:
Last Name:CRIMI
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 1:1431 SW 1ST AVE
Mailing Address - Street 2:OCALA REGIONAL MEDICAL CENTER
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6500
Mailing Address - Country:US
Mailing Address - Phone:617-697-2861
Mailing Address - Fax:
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:OCALA REGIONAL MEDICAL CENTER
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:617-697-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107037207L00000X, 207LC0200X, 207LC0200X
MAL-226216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003749100Medicaid
FL003749100Medicaid