Basic Information
| Provider Information | |||||||||
| NPI: | 1114139615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRESSWELL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2135 SOUTHGATE ROAD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809062605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196334114 | ||||||||
| FaxNumber: | 7195785407 | ||||||||
| Practice Location | |||||||||
| Address1: | 2135 SOUTHGATE ROAD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809062605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196334114 | ||||||||
| FaxNumber: | 7195785407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 21360 | CO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 01213602 | 05 | CO | MEDICAID |