Provider Demographics
NPI:1851371686
Name:WARDELL, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:WARDELL
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 1:7924 E SHIMMERING WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1272
Mailing Address - Country:US
Mailing Address - Phone:520-733-2245
Mailing Address - Fax:
Practice Address - Street 1:4175 S ALAMO AVE
Practice Address - Street 2:
Practice Address - City:DAVIS MONTHAN A F B
Practice Address - State:AZ
Practice Address - Zip Code:85707-6097
Practice Address - Country:US
Practice Address - Phone:520-228-1593
Practice Address - Fax:520-228-8763
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine