Provider Demographics
NPI:1366496150
Name:WAMSLEY, CRAIG ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLAN
Last Name:WAMSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1401 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2037
Mailing Address - Country:US
Mailing Address - Phone:417-876-2511
Mailing Address - Fax:417-876-3812
Practice Address - Street 1:1401 S PARK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-2037
Practice Address - Country:US
Practice Address - Phone:417-876-2511
Practice Address - Fax:417-876-3812
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO109526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE69283Medicare UPIN