| Doctor Name: | DR. CRISANTO GUALBERTO |
| NPI Number: | 1043285398 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | R6651 |
| Business Practice Address: | 106 W State Street Vandalia, MO - 63382 |
| Business Phone Number: | 5735946208 |
| Business Fax Number: | 5735946780 |
| Mailing Address: | 106 W State Street, VANDALIA |
| State: | MO |
| Postal Code: | 633821239 |
| Phone Number: | 5735946208 |
| Fax Number: | |
| NPI Enumeration Date: | 02/21/2006 |
| NPI Last Update Date: | 12/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R6651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |