Provider Demographics
NPI:1376673178
Name:CRESPO, LUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:CRESPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3851
Mailing Address - Country:US
Mailing Address - Phone:813-286-2520
Mailing Address - Fax:813-286-2865
Practice Address - Street 1:5041 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3851
Practice Address - Country:US
Practice Address - Phone:813-286-2520
Practice Address - Fax:813-286-2865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046399204C00000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE53020Medicare UPIN