Provider Demographics
NPI:1588619704
Name:CRAIG, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
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 1:98 SHERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:55552
Mailing Address - Country:US
Mailing Address - Phone:715-762-2484
Mailing Address - Fax:715-762-7503
Practice Address - Street 1:98 SHERRY AVENUE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:55552
Practice Address - Country:US
Practice Address - Phone:715-762-2484
Practice Address - Fax:715-762-7503
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39840207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39840OtherSTATE LICENSE NUMBER
WI34377300Medicaid
BC8152465OtherDEA NUMBER
BC8152465OtherDEA NUMBER