Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MD 024907 | LA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 28692 | SC |
Y | 207X00000X | Orthopaedic Surgeon | 28692 | SC |
NPI | 1457309098 |
---|---|
Provider Name | Dr. Lucius Craig III |
First Address | Orangeburg, SC 29116-1245 |
Second Address | Terrytown, LA 70056-7156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28692 | MEDICAL LICENSE (01) | SC |
I 35421 | (02) | LA |
M1607 | TEXAS MEDICAL LICENSE (01) | TX |
MD024907 | LA STATE MEDICAL LICENSE (01) | LA |