Provider Demographics
NPI:1821070731
Name:CREED, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:CREED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 664056
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4056
Mailing Address - Country:US
Mailing Address - Phone:317-862-6609
Mailing Address - Fax:317-862-4617
Practice Address - Street 1:8325 E SOUTHPORT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-6805
Practice Address - Country:US
Practice Address - Phone:317-862-6609
Practice Address - Fax:317-862-4617
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022130A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100219830AMedicaid
IN100219830AMedicaid
725740Medicare ID - Type Unspecified