Provider Demographics
NPI:1982603528
Name:CREECH, FRED TARRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:TARRY
Last Name:CREECH
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:304 DEL PRADO BLVD S
Mailing Address - Street 2:UNIT C
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5705
Mailing Address - Country:US
Mailing Address - Phone:239-458-1700
Mailing Address - Fax:239-458-1887
Practice Address - Street 1:304 DEL PRADO BLVD S
Practice Address - Street 2:UNIT C
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5705
Practice Address - Country:US
Practice Address - Phone:239-458-1700
Practice Address - Fax:239-458-1887
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2012-09-26
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Provider Licenses
StateLicense IDTaxonomies
FLME 72519207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA11925Medicare UPIN