Provider Demographics
NPI:1568798387
Name:CRAIG, LANCE ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ANTHONY
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 1:2100 HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5505
Mailing Address - Country:US
Mailing Address - Phone:409-724-2321
Mailing Address - Fax:409-729-7237
Practice Address - Street 1:2100 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5505
Practice Address - Country:US
Practice Address - Phone:409-724-2321
Practice Address - Fax:409-729-7237
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FX93Medicare PIN