Provider Demographics
NPI:1689750150
Name:BAINBRIDGE, CRAIG WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WAYNE
Last Name:BAINBRIDGE
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 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:712-255-8827
Mailing Address - Fax:712-255-4862
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-255-8827
Practice Address - Fax:712-255-4862
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19741207R00000X, 207RC0200X, 207RP1001X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00724601OtherRR MEDICARE
IAA01592Medicare UPIN