Provider Demographics
NPI:1942292784
Name:CRUMP, CLIFFORD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:MICHAEL
Last Name:CRUMP
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 1:15335 SW 288TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1356
Mailing Address - Country:US
Mailing Address - Phone:305-248-3814
Mailing Address - Fax:305-246-0453
Practice Address - Street 1:15335 SW 288TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1356
Practice Address - Country:US
Practice Address - Phone:305-248-3814
Practice Address - Fax:305-246-0453
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95204Medicare PIN
FLD63366Medicare UPIN