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General NPI Number Information
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NPI Number | 1003828633
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Entity Type | Individual
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Provider Name | WILLIAM D CRECELIUS MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR STE 203
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4150
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Country | US
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Telephone | 760-834-3593
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Fax | 760-674-3845
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Provider Business Mailing Address
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Address Line | 39000 BOB HOPE DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3221
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Country | US
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Telephone | 760-834-3593
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Fax | 760-674-3845
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 28795
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 28795
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G138326
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License Number State | CA
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