Provider Demographics
NPI:1780651968
Name:KUEBKER, CRAIG WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:KUEBKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9480 HUEBNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1655
Mailing Address - Country:US
Mailing Address - Phone:210-614-8090
Mailing Address - Fax:210-614-8151
Practice Address - Street 1:9480 HUEBNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1655
Practice Address - Country:US
Practice Address - Phone:210-614-8090
Practice Address - Fax:210-614-8151
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD95812Medicare UPIN
TX8D2731Medicare PIN