Provider Demographics
NPI:1104965490
Name:CRECCA, GERARD FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:FRANCIS
Last Name:CRECCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 CURIE DR
Mailing Address - Street 2:SUITE 5300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2905
Mailing Address - Country:US
Mailing Address - Phone:915-542-2825
Mailing Address - Fax:915-542-1713
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:SUITE 5300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-542-2825
Practice Address - Fax:915-542-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG0981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089718301Medicaid
TX089718301Medicaid
B22017Medicare UPIN