Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 9598 | MT |
Y | 208600000X | Surgeon | 9598 | MT |
N | 2086S0129X | Vascular Surgeon | 9598 | MT |
NPI | 1013957695 |
---|---|
Provider Name | John R Craig |
First Address | Kalispell, MT 59901-4844 |
Second Address | Kalispell, MT 59901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000094271 | BCSB PIN (01) | MT |
0035615 | MDCD PIN (01) | MT |
116170900 | MDCD PIN (01) | WY |
H36117 | (02) | MT |