MEDICARE: DR. CRAIG NORMAN CREASMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	G65665	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G65665	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1609839372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG NORMAN CREASMAN M.D.

Provider Business Mailing Address
First Line	:	2400 SAMARITAN DR
Second Line	:	SUITE 206
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3910
Country	:	US
Telephone Number	:	408-369-9300
Fax Number	:	408-369-9599

Provider Business Practice Location Address
First Line	:	2400 SAMARITAN DR
Second Line	:	SUITE 206
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3910
Country	:	US
Telephone Number	:	408-369-9300
Fax Number	:	408-369-9599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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