Provider Demographics
NPI:1043219033
Name:CRAIG, SUSAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 COLLEGE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-835-2300
Mailing Address - Fax:409-835-2375
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-835-2300
Practice Address - Fax:409-835-2375
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ613OtherBCBS PROVIDER NUMBER
TX142758501Medicaid
G72035Medicare UPIN
TXP00324176Medicare PIN
TX8F3048Medicare PIN