| Doctor Name: | DR. CRYSTAL VAUGHN KONDOWE |
| NPI Number: | 1366702870 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 0101255760 |
| Business Practice Address: | 2200 Bergquist Dr Wilford Hall Ambulatory Surgical Center Lackland A F B, TX - 782369907 |
| Business Phone Number: | 2102927805 |
| Business Fax Number: | 2102927868 |
| Mailing Address: | 310w Losey St, Internal Medicine Clinic SCOTT AIR FORCE BASE |
| State: | IL |
| Postal Code: | 622255250 |
| Phone Number: | 6182569355 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2012 |
| NPI Last Update Date: | 07/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101255760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |