Provider Demographics
NPI:1043928476
Name:CREOSOTE TOTAL HEALTH PC
Entity type:Organization
Organization Name:CREOSOTE TOTAL HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-269-3208
Mailing Address - Street 1:8380 S KYRENE RD # D-103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2120
Mailing Address - Country:US
Mailing Address - Phone:480-269-3208
Mailing Address - Fax:480-674-1295
Practice Address - Street 1:8380 S KYRENE RD # D-103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2120
Practice Address - Country:US
Practice Address - Phone:480-269-3208
Practice Address - Fax:480-674-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty