Provider Demographics
NPI:1558328179
Name:CRAIG II, PAUL WILSON (MD, CIME, AAMRO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILSON
Last Name:CRAIG II
Suffix:
Gender:M
Credentials:MD, CIME, AAMRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1709 KY ROUTE 321 STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:6500 HIGHWAY 645
Practice Address - Street 2:SUITE 110
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224
Practice Address - Country:US
Practice Address - Phone:606-298-3412
Practice Address - Fax:606-298-3416
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV18116207QA0401X, 207QA0505X, 2083A0100X, 2083P0500X
KY299122083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100304610Medicaid
WV262225539OtherFEIN