Provider Demographics
NPI:1518015536
Name:GOOLSBY, CRAIG A (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:GOOLSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5900
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-615-7170
Practice Address - Street 1:8401 DATAPOINT DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5900
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-615-7170
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TX8BZ138OtherBCBSTX
TX8BZ138OtherBCBSTX