Provider Demographics
NPI:1033315858
Name:FRED T CREECH MD PA
Entity type:Organization
Organization Name:FRED T CREECH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:239-458-1700
Mailing Address - Street 1:304 DEL PRADO BLVD S STE C
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5704
Mailing Address - Country:US
Mailing Address - Phone:239-458-1700
Mailing Address - Fax:239-458-1887
Practice Address - Street 1:304 DEL PRADO BLVD S STE C
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5704
Practice Address - Country:US
Practice Address - Phone:239-458-1700
Practice Address - Fax:239-458-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72519207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty