Provider Demographics
NPI:1689634453
Name:CRAIGHEAD, C CLAY III (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:CLAY
Last Name:CRAIGHEAD
Suffix:III
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 1:1124 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1951
Mailing Address - Country:US
Mailing Address - Phone:985-384-3171
Mailing Address - Fax:985-384-3173
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-384-3171
Practice Address - Fax:985-384-3173
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348261Medicaid
5M289Medicare ID - Type Unspecified
LA1348261Medicaid