Provider Demographics
NPI:1124008032
Name:CREPPS, JOSEPH THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:CREPPS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3220 ORION DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-0920
Mailing Address - Country:US
Mailing Address - Phone:719-632-2877
Mailing Address - Fax:719-632-2877
Practice Address - Street 1:3220 ORION DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-0920
Practice Address - Country:US
Practice Address - Phone:719-632-2877
Practice Address - Fax:719-632-2877
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN320232086S0129X
CO311242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311240Medicaid
COCN3218Medicare Oscar/Certification
COB41186Medicare UPIN
COCOA103059Medicare PIN