Provider Demographics
NPI:1073742425
Name:SHUTE, CREIGHTON E (DO)
Entity Type:Individual
Prefix:DR
First Name:CREIGHTON
Middle Name:E
Last Name:SHUTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 JOHNSTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5334
Mailing Address - Country:US
Mailing Address - Phone:337-703-0703
Mailing Address - Fax:337-703-0704
Practice Address - Street 1:5750 JOHNSTON ST STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5334
Practice Address - Country:US
Practice Address - Phone:337-703-0703
Practice Address - Fax:337-703-0704
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000309207QS0010X, 207Q00000X, 207P00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM