Provider Demographics
NPI:1073934626
Name:CRADDOCK, DAVID ALAN
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:CRADDOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:ALAN
Other - Last Name:CRADDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:27660 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6674
Mailing Address - Country:US
Mailing Address - Phone:949-951-7111
Mailing Address - Fax:949-951-2524
Practice Address - Street 1:27660 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6674
Practice Address - Country:US
Practice Address - Phone:949-951-7111
Practice Address - Fax:949-951-2524
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine