Provider Demographics
NPI:1639193956
Name:WHITCOMB, CLARENCE C (MD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:C
Last Name:WHITCOMB
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 1:11700 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4071
Mailing Address - Country:US
Mailing Address - Phone:305-253-3885
Mailing Address - Fax:
Practice Address - Street 1:11700 SW 104TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4071
Practice Address - Country:US
Practice Address - Phone:305-253-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38821207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0401901-00Medicaid
FLC65355Medicare UPIN
FL96112Medicare ID - Type Unspecified