Provider Demographics
NPI:1457309098
Name:CRAIG, LUCIUS III (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIUS
Middle Name:
Last Name:CRAIG
Suffix:III
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 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:803-395-2237
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:SUITE I
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-391-7670
Practice Address - Fax:504-378-9437
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 024907204C00000X
SC28692204D00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM1607OtherTEXAS MEDICAL LICENSE
SC28692OtherMEDICAL LICENSE
LAMD024907OtherLA STATE MEDICAL LICENSE
LAI 35421Medicare UPIN