Healthcare Provider Details

I. General information

NPI: 1578884540
Provider Name (Legal Business Name): DUSTIN A CREECH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR
MORRILTON AR
72110-4510
US

IV. Provider business mailing address

180 S 3RD ST
BELLEVILLE IL
62220-1952
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-0052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-7331
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: