Provider Demographics
NPI:1790744456
Name:CREAN, JAN LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:LESLIE
Last Name:CREAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 LAKE WAY PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4740
Mailing Address - Country:US
Mailing Address - Phone:931-455-1177
Mailing Address - Fax:931-461-3091
Practice Address - Street 1:603 LAKE WAY PL
Practice Address - Street 2:SUITE B
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4740
Practice Address - Country:US
Practice Address - Phone:931-455-1177
Practice Address - Fax:931-461-3091
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN036135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4252143OtherBCBS
TN3875474Medicare ID - Type Unspecified
TN4252143OtherBCBS