Provider Demographics
NPI:1164730677
Name:LIDDLE, CRAIG MARTIN
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MARTIN
Last Name:LIDDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:CLAY SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:85923-0855
Mailing Address - Country:US
Mailing Address - Phone:623-258-2891
Mailing Address - Fax:
Practice Address - Street 1:4751 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:CLAY SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:85923
Practice Address - Country:US
Practice Address - Phone:623-258-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2527515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist