Provider Demographics
NPI:1972510790
Name:CRAIG, DAVID MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARSHALL
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 S YALE AVE STE 1020
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8323
Mailing Address - Country:US
Mailing Address - Phone:918-481-2900
Mailing Address - Fax:918-481-2985
Practice Address - Street 1:6585 S YALE AVE STE 1020
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8323
Practice Address - Country:US
Practice Address - Phone:918-481-2900
Practice Address - Fax:918-481-2985
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17252O2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100145060AMedicaid
OKE07082Medicare UPIN