Provider Demographics
NPI:1932109279
Name:CRAIG, TERESA G (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:G
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3300 NW 56TH
Mailing Address - Street 2:STE LL100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4499
Mailing Address - Country:US
Mailing Address - Phone:405-488-0700
Mailing Address - Fax:405-488-0701
Practice Address - Street 1:3300 NW 56TH ST
Practice Address - Street 2:STE LL100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4538
Practice Address - Country:US
Practice Address - Phone:405-488-0700
Practice Address - Fax:405-488-0701
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK157062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK920007374Medicare PIN
OK247235401Medicare PIN