Provider Demographics
NPI:1922327808
Name:ROBERTS, CRAIG ALAN
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALAN
Last Name:ROBERTS
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 1:234 NW ALEJANDRA WAY
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-2128
Mailing Address - Country:US
Mailing Address - Phone:580-917-2585
Mailing Address - Fax:580-510-2777
Practice Address - Street 1:234 NW ALEJANDRA WAY
Practice Address - Street 2:
Practice Address - City:CACHE
Practice Address - State:OK
Practice Address - Zip Code:73527-2128
Practice Address - Country:US
Practice Address - Phone:580-917-2585
Practice Address - Fax:580-510-2777
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren