Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | R9N78 | MO |
NPI | 1265436711 |
---|---|
Provider Name | Robert Daniel Craig |
First Address | Saint Louis, MO 63141-8789 |
Second Address | Saint Louis, MO 63141-8789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 02/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D34550 | (02) | MO |