Provider Demographics
NPI:1659354124
Name:CRAIG, JODIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:LYNN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 VERNIER PL
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-1006
Mailing Address - Country:US
Mailing Address - Phone:650-493-2693
Mailing Address - Fax:650-424-1972
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:PSSB SUITE 100B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80355207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine