Healthcare Provider Details

I. General information

NPI: 1376673178
Provider Name (Legal Business Name): LUIS E CRESPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 W CYPRESS ST
TAMPA FL
33607-3851
US

IV. Provider business mailing address

5041 W CYPRESS ST
TAMPA FL
33607-3851
US

V. Phone/Fax

Practice location:
  • Phone: 813-286-2520
  • Fax: 813-286-2865
Mailing address:
  • Phone: 813-286-2520
  • Fax: 813-286-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME0046399
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME0046399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: