Healthcare Provider Details

I. General information

NPI: 1679622591
Provider Name (Legal Business Name): PATRICK J MCCREESH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 NEWHALL ST
SAN JOSE CA
95126-1032
US

IV. Provider business mailing address

902 NEWHALL ST
SAN JOSE CA
95126-1032
US

V. Phone/Fax

Practice location:
  • Phone: 408-249-6760
  • Fax:
Mailing address:
  • Phone: 408-249-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG59665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: