Provider Demographics
NPI:1962504787
Name:DOLVEN, CRAIG A (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:DOLVEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1594 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4546
Mailing Address - Country:US
Mailing Address - Phone:904-264-8621
Mailing Address - Fax:904-215-9418
Practice Address - Street 1:1825 KINGSLEY AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4484
Practice Address - Country:US
Practice Address - Phone:904-264-8621
Practice Address - Fax:904-215-9418
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015808300Medicaid
MI3235477Medicaid
FLIL305ZMedicare PIN
FL015808300Medicaid
MIM23560021Medicare PIN