Provider Demographics
NPI:1144236787
Name:WILLIAMS, CRAIG W (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:70 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-6071
Mailing Address - Fax:573-334-4739
Practice Address - Street 1:70 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-6071
Practice Address - Fax:573-334-4739
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7E692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
063896OtherHEALTH ALLIANCE
430954380CAPOtherMERCY HEALTH PLAN
MO185214Other185214
MO202911608Medicaid
182190OtherHEALTHLINK
AR143788001Medicaid
IL036-070749OtherIL BLUE CROSS BLUE SHIELD
MO300022095Medicare ID - Type UnspecifiedMO RAILROAD MEDICARE
063896OtherHEALTH ALLIANCE
IL036-070749OtherIL BLUE CROSS BLUE SHIELD
A12100Medicare UPIN
AR143788001Medicaid