Peter W Crecelius, MD
Individual provider Active NPI Family Medicine Physician · Orofino, ID
NPI 1659376010 · NPPES record last updated May 11, 2009
Key facts
- NPI
- 1659376010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M4777 (ID)
- Practice address
- 301 Cedar St
Orofino, ID 83544-9029 - Phone
- (208) 476-4555
- Fax
- (208) 476-5385
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4777 | ID | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4777 | ID | Yes |
Addresses
Primary practice location
301 Cedar St
Orofino, ID 83544-9029
Mailing address
301 Cedar St
Orofino, ID 83544-9029
Phone (208) 476-4555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B63862 | Other | ID | UPIN # |
| 000175600 | Medicaid | ID |
Other providers in Orofino, ID
- Nicole Cleveland
- Tammy Jo Cochrane
- Compcare Inc
- Compcare Inc
- Loyce Lee Crawford
- Andrew Cyr
- Adam C Dayley
- Joanne Evelyn Deyo
- Discover Chiropractic Group PLLC
- Dr James Said Chiropractic and Naturopathic Physician Inc
All providers in Orofino, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.