Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 018184 | LA |
NPI | 1174589758 |
---|---|
Provider Name | Dr. Terry Creel |
First Address | San Antonio, TX 78229-5907 |
Second Address | Metairie, LA 70006-2970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1365246 | (05) | LA |
B64098 | (02) | LA |
H4048Z | BCBS (01) | LA |