Individual
DR. RICHARD J. CRETELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 ROUND ROCK AVE, ROUND ROCK, TX 78681-4004
(512) 341-1000
Mailing address
310 MICKELSON LN, GEORGETOWN, TX 78628-0913
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L2200
TX
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
L2200
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166957401
—
TX
05
—
166957402
—
TX
01
—
8B8464
BC/BS OF TEXAS
TX
Enumeration date
09/28/2006
Last updated
05/24/2010
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