Provider Demographics
NPI:1942390059
Name:ALTUS, CRAIG SCOTT (MD, FCCP)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:SCOTT
Last Name:ALTUS
Suffix:
Gender:M
Credentials:MD, FCCP
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 221257
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-1257
Mailing Address - Country:US
Mailing Address - Phone:561-835-6888
Mailing Address - Fax:561-835-3888
Practice Address - Street 1:5555 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-7815
Practice Address - Country:US
Practice Address - Phone:561-840-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49322207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047554800Medicaid
FLD61110Medicare UPIN
FL04592Medicare ID - Type Unspecified