Healthcare Provider Details

I. General information

NPI: 1316938699
Provider Name (Legal Business Name): CLINTON C. PITTMAN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS PITTMAN MD

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 W VIRGINIA AVE STE A
TAMPA FL
33607-6357
US

IV. Provider business mailing address

1099 SHIPWATCH CIR
TAMPA FL
33602-5736
US

V. Phone/Fax

Practice location:
  • Phone: 855-834-6911
  • Fax: 813-443-5600
Mailing address:
  • Phone: 855-834-6911
  • Fax: 813-443-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME0064760
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME64760
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME0064760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: