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General NPI Number Information
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NPI Number | 1942410980
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Entity Type | Individual
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Provider Name | TINA L CREEKMORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 7301 HENNESSY BLVD SUITE 200
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City | BATON ROUGE
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State | LA
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Zip | 70808-4384
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Country | US
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Telephone | 225-765-6453
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Fax | 225-768-2424
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Provider Business Mailing Address
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Address Line | 4499 MEDICAL DR STE 235
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3712
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Country | US
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Telephone | 210-692-1613
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 026892
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | N2454
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License Number State | TX
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