Provider Demographics
NPI:1902822844
Name:CRADDOCK, HARVEY R (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:R
Last Name:CRADDOCK
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6292
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-6292
Mailing Address - Country:US
Mailing Address - Phone:270-317-4827
Mailing Address - Fax:270-234-8558
Practice Address - Street 1:258 CORVIN LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5771
Practice Address - Country:US
Practice Address - Phone:270-317-4827
Practice Address - Fax:270-234-8558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA011246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist