Healthcare Provider Details

I. General information

NPI: 1366435877
Provider Name (Legal Business Name): DAVID MARC TAN CRETI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 HWY 30 E
DENISON IA
51442-2139
US

IV. Provider business mailing address

95 MORNINGVIEW ST
DENISON IA
51442-2237
US

V. Phone/Fax

Practice location:
  • Phone: 712-263-6116
  • Fax: 712-263-6115
Mailing address:
  • Phone: 712-263-6116
  • Fax: 712-263-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18503
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: