Provider Demographics
NPI:1326021528
Name:CHASE, CRAIG P (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2441 WEST STATE ROAD 426
Mailing Address - Street 2:SUITE 2011
Mailing Address - City:OVEIDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4515
Mailing Address - Country:US
Mailing Address - Phone:407-678-6888
Mailing Address - Fax:407-678-0252
Practice Address - Street 1:2441 WEST STATE ROAD 426
Practice Address - Street 2:SUITE 2011
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4515
Practice Address - Country:US
Practice Address - Phone:407-678-6888
Practice Address - Fax:407-678-0252
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0074034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG66144Medicare UPIN
FL42741XMedicare ID - Type Unspecified