Healthcare Provider Details

I. General information

NPI: 1275928889
Provider Name (Legal Business Name): ALEJANDRO JESUS CRACCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 BAYSHORE BLVD
TAMPA FL
33606-2707
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-5460
  • Fax: 813-844-1655
Mailing address:
  • Phone: 813-844-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036155358
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME178000
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberTP726
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number58643
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: