Provider Demographics
NPI:1245371814
Name:CREIGHTON, WILLIAM DODSON (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DODSON
Last Name:CREIGHTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 W LEGION RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7727
Mailing Address - Country:US
Mailing Address - Phone:760-344-7412
Mailing Address - Fax:760-344-9956
Practice Address - Street 1:197 W LEGION RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7727
Practice Address - Country:US
Practice Address - Phone:760-344-7412
Practice Address - Fax:760-344-9956
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G277440Medicaid
CA00G277440Medicaid
CAA43476Medicare UPIN