Provider Demographics
NPI:1336876564
Name:CREASON, RICKY MATHEW
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:MATHEW
Last Name:CREASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 E ADMIRAL PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74110-5436
Mailing Address - Country:US
Mailing Address - Phone:918-262-4550
Mailing Address - Fax:
Practice Address - Street 1:2727 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-5436
Practice Address - Country:US
Practice Address - Phone:918-262-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist