Provider Demographics
NPI:1134100787
Name:ENGLUND, CRAIG WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WARREN
Last Name:ENGLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SE 5TH TER
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4852
Mailing Address - Country:US
Mailing Address - Phone:352-795-6674
Mailing Address - Fax:
Practice Address - Street 1:770 SE 5TH TER
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4852
Practice Address - Country:US
Practice Address - Phone:352-795-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43357207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048444000Medicaid
FL048444000Medicaid
FL02268Medicare ID - Type UnspecifiedMEDICARE ID