Active NPI
David Marc Tan Creti, MD
- Family Medicine Physician
- Denison, IA
National Provider Identifier
1366435877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 18503
- Practice address
- 1820 Hwy 30 E
Denison, IA 51442-2139 - Phone
- (712) 263-6116
- Fax
- (712) 263-6115
- NPI assigned
- Aug 30, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18503 | IA | Primary |
Addresses
Primary practice location
1820 Hwy 30 E
Denison, IA 51442-2139
Mailing address
95 Morningview St
Denison, IA 51442-2237
Phone (712) 263-6116
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0222711 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18503 | IA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320019200000",
"number": "1366435877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 MORNINGVIEW ST",
"city": "DENISON",
"state": "IA",
"postal_code": "514422237",
"telephone_number": "712-263-6116",
"fax_number": "712-263-6115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 HWY 30 E",
"city": "DENISON",
"state": "IA",
"postal_code": "514422139",
"telephone_number": "712-263-6116",
"fax_number": "712-263-6115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN CRETI",
"first_name": "DAVID",
"middle_name": "MARC",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-30",
"last_updated": "2011-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "18503",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0222711",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denison, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.