Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 9090 | NC |
N | 1223G0001X | General Practice | 150818 | NC |
N | 213EG0000X | General Practice | 150818 | NC |
NPI | 1699077800 |
---|---|
Provider Name | Dr. Robert Craig |
First Address | Faison, NC 28341-8820 |
Second Address | Goldsboro, NC 27530-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2010 |
Last Update Date | 23/03/2016 |