MEDICARE: DR. CLARA SMITH CREIGHTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	ME38694	FL

General Provider Information

NPI Number	:	1902215544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARA SMITH CREIGHTON M.D.

Provider Business Mailing Address
First Line	:	9724 N ARMENIA AVE
Second Line	:	STE 100
City	:	TAMPA
State	:	FL
Zip	:	33612-7550
Country	:	US
Telephone Number	:	813-915-8666
Fax Number	:	813-930-9536

Provider Business Practice Location Address
First Line	:	9724 N ARMENIA AVE
Second Line	:	STE 100
City	:	TAMPA
State	:	FL
Zip	:	33612-7550
Country	:	US
Telephone Number	:	813-915-8666
Fax Number	:	813-930-9536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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