Provider Demographics
NPI:1902131170
Name:CREEKMORE, SARA JEANNETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JEANNETTE
Last Name:CREEKMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JEANNETTE
Other - Last Name:TOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328-A CUMMINGS ST.
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210
Mailing Address - Country:US
Mailing Address - Phone:276-628-3118
Mailing Address - Fax:276-628-8342
Practice Address - Street 1:328-A CUMMINGS ST.
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-3118
Practice Address - Fax:276-628-8342
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0803207W00000X
FLUO2252207Q00000X
VA0102204017207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902131170Medicaid
VA1902131170Medicaid