Individual
DR. CARL WAYNE CRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 259-0800
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME21250
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039206500
—
FL
01
—
30234
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/13/2006
Last updated
03/31/2021
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