Provider Demographics
NPI:1578544060
Name:PRICE, CRAIG G (PA)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:G
Last Name:PRICE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 MEDICAL DR.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4815
Mailing Address - Country:US
Mailing Address - Phone:210-614-6000
Mailing Address - Fax:210-614-7728
Practice Address - Street 1:5290 MEDICAL DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4815
Practice Address - Country:US
Practice Address - Phone:210-614-6000
Practice Address - Fax:210-614-7728
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00179363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00179OtherPA STATE LICENSE
8G0033Medicare PIN
TXQ53109Medicare UPIN
TX8G0033Medicare ID - Type Unspecified
TXPA00179OtherPA STATE LICENSE
Q53109Medicare UPIN