Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 31124 | CO |
N | 2086S0129X | Vascular Surgeon | 32023 | MN |
NPI | 1124008032 |
---|---|
Provider Name | Dr. Joseph Thomas Crepps JR. |
First Address | Colorado Springs, CO 80906-0920 |
Second Address | Colorado Springs, CO 80906-0920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 01/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01311240 | (05) | CO |
B41186 | (02) | CO |