Charles Ray Crispen Jr., D.O.
Individual provider Active NPI Pediatrics Physician · Las Vegas, NV
NPI 1750365409 · NPPES record last updated Apr 17, 2014
Key facts
- NPI
- 1750365409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- DO1575 (NV)
- Practice address
- 2604 High Range Dr
Las Vegas, NV 89134-7564 - Phone
- (702) 522-9203
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | DO14538 | OR | |
| Pediatrics Physician | 208000000X | DO1575 | NV | Yes |
Addresses
Primary practice location
2604 High Range Dr
Las Vegas, NV 89134-7564
Mailing address
2604 High Range Drive
Las Vegas, NV 89134
Phone (702) 522-9203
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299499 | Medicaid | OR |
Other providers in Las Vegas, NV
- John Joseph Criscuolo III
- Crisis Care and Life Enhancement Center LLC
- Crisis Care Recovery Center LLC
- Elyzabeth Crisostomo
- Jolene Cabrera Crisostomo
- Lisa Crist
- Elvira Cristi
- Camille Frieda Uy Cristobal
- Marian Cristobal
- Raquel Cristobal
All providers in Las Vegas, NV · Pediatrics Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.