Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 01055793A | IN |
NPI | 1124101969 |
---|---|
Provider Name | Dr. Robert Weldon Craig-Gray |
First Address | Upper Marlboro, MD 20774-7171 |
Second Address | Andrews Afb, MD 20762-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |