Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25633 | KY |
N | 207YP0228X | Pediatric Otolaryngology | 25633 | KY |
NPI | 1093749350 |
---|---|
Provider Name | James Michael Craven |
First Address | Ormond Beach, FL 32174-8154 |
Second Address | Ormond Beach, FL 32174-8154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 16/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040016956 | RR MEDICARE PIN (01) | GA |
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |
64047475 | (05) | KY |
CB5773 | RR MEDICARE GROUP (01) | GA |
H55144 | (02) |