Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 11091 | TN |
NPI | 1003898248 |
---|---|
Provider Name | David J Creutzinger |
First Address | Sweetwater, TN 37874-1181 |
Second Address | Sweetwater, TN 37874-1181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 25/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3171696 | (05) | TN |
B03485 | (02) | TN |