Provider Demographics
NPI:1609864750
Name:FURRY, CRAIG W (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:FURRY
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-5080
Mailing Address - Country:US
Mailing Address - Phone:618-542-2129
Mailing Address - Fax:618-542-2903
Practice Address - Street 1:20 N WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1403
Practice Address - Country:US
Practice Address - Phone:618-542-2129
Practice Address - Fax:618-542-2903
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
IL036067057207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL744481OtherMEDICARE NUMBER
IL036067057-3Medicaid
ILP00173490OtherIND # FOR NCP SO ILLINOIS
ILK07356Medicare PIN
ILP00173490OtherIND # FOR NCP SO ILLINOIS
IL148924Medicare Oscar/Certification