MEDICARE: JOSEPH CREAZZO JR. DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	000429	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	167149	OTHER	BC/BS
3	P00190667	OTHER	PALMETTO GBA

General Provider Information

NPI Number	:	1518955707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CREAZZO JR. DPM

Provider Business Mailing Address
First Line	:	2263 SANDSTONE DR
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-2593
Country	:	US
Telephone Number	:	423-581-0444
Fax Number	:	423-353-1209

Provider Business Practice Location Address
First Line	:	2263 SANDSTONE DR
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-2593
Country	:	US
Telephone Number	:	423-581-0444
Fax Number	:	423-353-1209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	01/03/2018

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