Provider Demographics
NPI:1942302880
Name:CRESPO, ISRAEL (M D)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:CRESPO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-930-8816
Mailing Address - Fax:813-932-1856
Practice Address - Street 1:6919 N DALE MABRY HWY STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3860
Practice Address - Country:US
Practice Address - Phone:813-930-8816
Practice Address - Fax:813-932-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67924207R00000X
FLME0067924207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377776600Medicaid
FL377776600Medicaid
FLG01068Medicare UPIN
FL26760Medicare PIN
FL26760YMedicare PIN