Provider Demographics
NPI:1790737310
Name:CRAIG, BRADLEY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:CRAIG
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:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0793
Mailing Address - Country:US
Mailing Address - Phone:509-826-1760
Mailing Address - Fax:509-826-7211
Practice Address - Street 1:810 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9578
Practice Address - Country:US
Practice Address - Phone:509-826-1760
Practice Address - Fax:509-826-7211
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025051207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA254327OtherL&I
A07625Medicare UPIN