Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 18116 | WV |
N | 207QA0505X | Family Doctor - Adult Medicine | 18116 | WV |
NPI | 1558328179 |
---|---|
Provider Name | Dr. Paul Wilson Craig Ii |
First Address | Prestonsburg, KY 41653-9097 |
Second Address | Inez, KY 41224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100304610 | (05) | KY |