Healthcare Provider Details

I. General information

NPI: 1124008032
Provider Name (Legal Business Name): JOSEPH THOMAS CREPPS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 ORION DR
COLORADO SPRINGS CO
80906-0920
US

IV. Provider business mailing address

3220 ORION DR
COLORADO SPRINGS CO
80906-0920
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-2877
  • Fax: 719-632-2877
Mailing address:
  • Phone: 719-632-2877
  • Fax: 719-632-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number32023
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number31124
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: