Provider Demographics
NPI:1073567756
Name:GREGORY M CREVER, MD, PC
Entity Type:Organization
Organization Name:GREGORY M CREVER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-991-3480
Mailing Address - Street 1:3370 N HAYDEN RD
Mailing Address - Street 2:SUITE 123 PMB 312
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6632
Mailing Address - Country:US
Mailing Address - Phone:480-991-3480
Mailing Address - Fax:480-991-1006
Practice Address - Street 1:8600 E VIA DE VENTURA STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3324
Practice Address - Country:US
Practice Address - Phone:480-991-3480
Practice Address - Fax:480-991-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH97045Medicare UPIN
AZZ109664Medicare PIN