Provider Demographics
NPI:1568409944
Name:DANSHAW, CRAIG B (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:DANSHAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 INTERNATIONAL PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4823
Mailing Address - Country:US
Mailing Address - Phone:817-529-2658
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:5801 OAKBEND TRL STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-370-4721
Practice Address - Fax:817-370-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1223207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135599206Medicaid
TX84340FMedicare PIN
TX135599206Medicaid