Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 32901 | FL |
NPI | 1043735285 |
---|---|
Provider Name | Matt Creamer |
First Address | Gulf Breeze, FL 32563-2873 |
Second Address | Gulf Breeze, FL 32561-7809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 09/08/2017 |