Provider Demographics
NPI:1972544153
Name:CRYSTAL, LUZ JOVITA (MD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:JOVITA
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:JOVITA
Other - Last Name:TORRALBA-CRYSTAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2202 JORDAN ROAD SW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3688
Mailing Address - Country:US
Mailing Address - Phone:256-844-2825
Mailing Address - Fax:256-844-2834
Practice Address - Street 1:2202 JORDAN ROAD SW
Practice Address - Street 2:SUITE 500
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3688
Practice Address - Country:US
Practice Address - Phone:256-844-2825
Practice Address - Fax:256-844-2834
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558061Medicaid
AL510-03925OtherBCBS
AL541385610Medicaid
AL051557585Medicaid
AL510-03714OtherBCBS
AL051558061Medicare PIN
ALG00910Medicare UPIN
ORP00348757Medicare PIN
AL051557585Medicaid
AL051557585Medicare PIN