Provider Demographics
NPI:1992000574
Name:CREASY, PATRICK TYE (PA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:TYE
Last Name:CREASY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 E WASHINGTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7111
Mailing Address - Country:US
Mailing Address - Phone:909-370-0300
Mailing Address - Fax:909-370-0303
Practice Address - Street 1:900 E WASHINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7111
Practice Address - Country:US
Practice Address - Phone:909-370-0300
Practice Address - Fax:909-370-0303
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21414363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical