Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 33062 | GA |
N | 208D00000X | General Practice Physician | ME 61513 | FL |
NPI | 1043279763 |
---|---|
Provider Name | Lawrence Eugene Crimmins |
First Address | Ormond Beach, FL 32176-3206 |
Second Address | Ormond Beach, FL 32176-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 20/03/2017 |