Provider Demographics
NPI:1982874715
Name:W DODSON CREIGHTON M D INC
Entity Type:Organization
Organization Name:W DODSON CREIGHTON M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALLERGY SPECIALISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DODSON
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-7412
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27744261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27744Medicaid
CAA43476Medicare UPIN
CAG27744Medicare PIN