Provider Demographics
NPI:1518955707
Name:CREAZZO, JOSEPH JR (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CREAZZO
Suffix:JR
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 1:2263 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-2593
Mailing Address - Country:US
Mailing Address - Phone:423-581-0444
Mailing Address - Fax:423-353-1209
Practice Address - Street 1:2263 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-2593
Practice Address - Country:US
Practice Address - Phone:423-581-0444
Practice Address - Fax:423-353-1209
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000429213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352049Medicaid
167149OtherBC/BS
P00190667OtherPALMETTO GBA
TN3352049Medicaid
3352049Medicare ID - Type Unspecified