Provider Demographics
NPI:1609848621
Name:CUPP, CRAIG LEE (MD, EDD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LEE
Last Name:CUPP
Suffix:
Gender:M
Credentials:MD, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1894
Mailing Address - Country:US
Mailing Address - Phone:360-475-4214
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47673207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery