Provider Demographics
NPI:1831130020
Name:CRAIG, WILLIAM RANDY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RANDY
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 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 320-330
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-781-5387
Mailing Address - Fax:417-781-7174
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:SUITE 320-330
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-5387
Practice Address - Fax:417-781-7174
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103131207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100257960BMedicaid
KS100311550GMedicaid
MOP00800262OtherRAIL ROAD MEDICARE
MO1831130020Medicaid
MO1831130020Medicaid
MOMA2082001Medicare PIN