Provider Demographics
NPI:1558637975
Name:FOLSOM, CRAIG ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROBERT
Last Name:FOLSOM
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 1:1601 CLINT MOORE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5712
Mailing Address - Country:US
Mailing Address - Phone:561-391-3333
Mailing Address - Fax:561-391-5618
Practice Address - Street 1:1601 CLINT MOORE RD STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5712
Practice Address - Country:US
Practice Address - Phone:561-391-3333
Practice Address - Fax:561-391-5618
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254433207Y00000X
390200000X
FLME152206207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program