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General NPI Number Information
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NPI Number | 1023138708
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Entity Type | Individual
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Provider Name | BRIAN CHRISTOPHER CREGHAN I PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 655 HARMON LOOP RD STE 102
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City | DEDEDO
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State | GU
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Zip | 96929-6544
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Country | US
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Telephone | 671-588-5268
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Fax | 671-989-8836
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Provider Business Mailing Address
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Address Line | 655 HARMON LOOP RD STE 102
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City | DEDEDO
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State | GU
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Zip | 96929-6544
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Country | US
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Telephone | 671-588-5268
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Fax | 352-481-5750
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101067
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101067
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-128
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License Number State | GU
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