Healthcare Provider Details

I. General information

NPI: 1609839372
Provider Name (Legal Business Name): CRAIG NORMAN CREASMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SAMARITAN DR SUITE 206
SAN JOSE CA
95124-3910
US

IV. Provider business mailing address

2400 SAMARITAN DR SUITE 206
SAN JOSE CA
95124-3910
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-9300
  • Fax: 408-369-9599
Mailing address:
  • Phone: 408-369-9300
  • Fax: 408-369-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG65665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: