Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30.015958 | OH |
NPI | 1871680108 |
---|---|
Provider Name | Dr. Robert Mitchell Craig JR. |
First Address | San Antonio, TX 78212-1763 |
Second Address | San Antonio, TX 78212-1763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |