Provider Demographics
NPI:1649780420
Name:CREASMAN, RONALD J
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:CREASMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 S JUNIPER VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-1700
Mailing Address - Country:US
Mailing Address - Phone:480-474-8828
Mailing Address - Fax:
Practice Address - Street 1:3969 S JUNIPER VILLAGE CT
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-1700
Practice Address - Country:US
Practice Address - Phone:480-474-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08314207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease