Provider Demographics
NPI:1417961277
Name:CREIGHTON, BARRY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:CREIGHTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 MIZELLE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-2383
Mailing Address - Country:US
Mailing Address - Phone:813-367-7299
Mailing Address - Fax:
Practice Address - Street 1:11012 MIZELLE CREEK TRL
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-2383
Practice Address - Country:US
Practice Address - Phone:813-367-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2827213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist