Provider Demographics
NPI:1184681967
Name:PETERSON, CRAIG A (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:PETERSON
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0384
Mailing Address - Country:US
Mailing Address - Phone:251-867-8001
Mailing Address - Fax:251-867-9643
Practice Address - Street 1:1123 BELLEVILLE AVENUE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1336
Practice Address - Country:US
Practice Address - Phone:251-867-8001
Practice Address - Fax:251-867-9643
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023588208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery