Provider Demographics
NPI:1689616849
Name:DELISI, CRAIG MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MARTIN
Last Name:DELISI
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 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:
Practice Address - Street 1:1610 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5614
Practice Address - Country:US
Practice Address - Phone:903-572-2273
Practice Address - Fax:903-572-0696
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158955801Medicaid
TX8A8514Medicare PIN
TX158955801Medicaid