Provider Demographics
NPI:1316938699
Name:PITTMAN, CLINTON C (M D)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:C
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1099 SHIPWATCH CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5736
Mailing Address - Country:US
Mailing Address - Phone:855-834-6911
Mailing Address - Fax:813-443-5600
Practice Address - Street 1:2815 W VIRGINIA AVE
Practice Address - Street 2:STE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6357
Practice Address - Country:US
Practice Address - Phone:855-834-6911
Practice Address - Fax:813-443-5600
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00647602085R0202X, 2085N0904X
FLME647602085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375122800Medicaid
FLP01549711OtherMEDICARE RAILROAD
FL170612OtherSUNSHINE
FL4602329OtherAETNA
FL1159488OtherWELLCARE
FL23826OtherBCBS
FL4602329OtherAETNA