Provider Demographics
NPI:1457745093
Name:CREAGH, JOHN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
Last Name:CREAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:786-596-3481
Mailing Address - Fax:786-533-9320
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:786-596-3481
Practice Address - Fax:786-533-9320
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085188208000000X
390200000X
FLME158216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty