Individual
JEFFREY LAWRENCE CRECELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
01036963A
IN
207T00000X
Neurological Surgery Physician
Primary
69263-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000580227
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
05
—
100087570
—
IN
01
—
10824947
CAQH NUMBER
IN
Enumeration date
03/14/2006
Last updated
03/31/2022
Update your record
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