Provider Demographics
NPI:1700939568
Name:CRESS, CLARENE J (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENE
Middle Name:J
Last Name:CRESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:10330 N DALE MABRY HWY STE 190
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4404
Practice Address - Country:US
Practice Address - Phone:813-963-7788
Practice Address - Fax:813-443-8149
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123259208000000X
NY131798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100790DLOtherPREFERRED CARE
NY010131798OtherBLUE CHOICE
NY9626OtherBLUE CROSS&BLUE SHIELD
NY00449505Medicaid
FL019742800Medicaid