Healthcare Provider Details

I. General information

NPI: 1336345735
Provider Name (Legal Business Name): WILLIAM ROBERT CRUMBLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E BUSCH BLVD SUITE 103
TAMPA FL
33612-8502
US

IV. Provider business mailing address

1010 E BUSCH BLVD SUITE 103
TAMPA FL
33612-8502
US

V. Phone/Fax

Practice location:
  • Phone: 813-935-7987
  • Fax: 813-931-5215
Mailing address:
  • Phone: 813-935-7987
  • Fax: 813-931-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME68820
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME68820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: