Provider Demographics
NPI:1508936436
Name:CRAIG, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:CRAIG
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 1:105 W 8TH AVE
Mailing Address - Street 2:STE 6080
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2313
Mailing Address - Country:US
Mailing Address - Phone:509-838-6500
Mailing Address - Fax:509-838-6561
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE 6080
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2313
Practice Address - Country:US
Practice Address - Phone:509-838-6500
Practice Address - Fax:509-838-6561
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0029482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8135972Medicaid
WAF18396Medicare UPIN
WA8850001Medicare ID - Type Unspecified