Provider Demographics
NPI:1821083379
Name:SMITH, CRAIG DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:SMITH
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 1:12222 MERIT DR
Mailing Address - Street 2:STE 1420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2283
Mailing Address - Country:US
Mailing Address - Phone:972-233-6237
Mailing Address - Fax:972-233-1734
Practice Address - Street 1:12222 MERIT DR
Practice Address - Street 2:SUITE 1420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2217
Practice Address - Country:US
Practice Address - Phone:972-233-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BE45OtherBCBS
TX00BE45OtherBCBS
TX00633YMedicare PIN