Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 17760 | AZ |
Y | 207VE0102X | Reproductive Endocrinologist | 17760 | AZ |
N | 208D00000X | General Practice Physician | 17760 | AZ |
NPI | 1144280249 |
---|---|
Provider Name | Dr. Randall Craig |
First Address | Tempe, AZ 85284-2604 |
Second Address | Tempe, AZ 85284-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104597 | (05) | AZ |
E52286 | (02) |