Provider Demographics
NPI:1861463937
Name:CAZENAVE, CRAIG R (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:CAZENAVE
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 1:1000 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6708
Mailing Address - Country:US
Mailing Address - Phone:614-210-1885
Mailing Address - Fax:
Practice Address - Street 1:1000 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6708
Practice Address - Country:US
Practice Address - Phone:614-210-1885
Practice Address - Fax:614-210-1886
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME425842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104206Medicaid
AL104468Medicaid
AL107070Medicaid
AL109478Medicaid
AL000101258Medicaid
AL108288Medicaid
AL104470Medicaid
AL104236Medicaid
AL104466Medicaid
AL104205Medicaid
FL048160200Medicaid
FL05668OtherBCBS
AL104250Medicaid
AL107073Medicaid
AL104239Medicaid
AL108893Medicaid
FL05668OtherBCBS
FL05668ZMedicare ID - Type Unspecified
AL104205Medicaid
AL104239Medicaid
AL104250Medicaid
AL000101258Medicaid
FL048160200Medicaid