Provider Demographics
NPI:1366435877
Name:TAN CRETI, DAVID MARC (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARC
Last Name:TAN CRETI
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 1:95 MORNINGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2237
Mailing Address - Country:US
Mailing Address - Phone:712-263-6116
Mailing Address - Fax:712-263-6115
Practice Address - Street 1:1820 HWY 30 E
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2139
Practice Address - Country:US
Practice Address - Phone:712-263-6116
Practice Address - Fax:712-263-6115
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0222711Medicaid
IA0222711Medicaid
IA22271Medicare ID - Type Unspecified