Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | ME68820 | FL |
N | 208D00000X | General Practice Physician | ME68820 | FL |
NPI | 1336345735 |
---|---|
Provider Name | Dr. William Robert Crumbley |
First Address | Tampa, FL 33612-8502 |
Second Address | Tampa, FL 33612-8502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F68019 | (02) | FL |
ME68820 | STATE LICENSE INFORMATION (01) | FL |