Provider Demographics
NPI:1487631065
Name:CREIGHTON, ROBERT E (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
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 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4168
Mailing Address - Country:US
Mailing Address - Phone:813-254-6592
Mailing Address - Fax:813-254-3634
Practice Address - Street 1:3491 GANDY BLVD N STE 107
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2652
Practice Address - Country:US
Practice Address - Phone:727-384-5540
Practice Address - Fax:727-384-5520
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002015213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2700457OtherUNITED HEALTHCARE
FL65137OtherBLUE CROSS BLUE SHIELD
FL65137YMedicare ID - Type Unspecified
FL480023520Medicare PIN
FL2700457OtherUNITED HEALTHCARE