Provider Demographics
NPI:1891876173
Name:CRAIG, MARK STEPHEN
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DWIGHT D. EISENHOWER ARMY MEDICAL CENTER
Mailing Address - Street 2:300 E. HOSPITAL RD.
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:253-948-4858
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:DWIGHT D. EISENHOWER ARMY MEDICAL CENTER
Practice Address - Street 2:300 E. HOSPITAL RD
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-1100
Practice Address - Country:US
Practice Address - Phone:253-948-4858
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI13944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics