Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 14202 | NV |
Y | 111NI0900X | Internist | 14202 | NV |
N | 207RG0300X | Geriatric Medicine | 14202 | NV |
N | 208D00000X | General Practice Physician | MD09249 | OR |
NPI | 1053643007 |
---|---|
Provider Name | Dr. William Robert Craig |
First Address | Reno, NV 89502-0837 |
Second Address | Reno, NV 89502-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053643007 | (05) | NV |
12306007 | CAQH (01) |