Provider Demographics
NPI:1013957695
Name:CRAIG, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
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 1:1333 SURGICAL SERVICES WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4844
Mailing Address - Country:US
Mailing Address - Phone:406-752-5000
Mailing Address - Fax:
Practice Address - Street 1:1333 SURGICAL SERVICES WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT95982086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116170900OtherMDCD PIN
MT000094271OtherBCSB PIN
MT0035615OtherMDCD PIN
MT0035615OtherMDCD PIN
WY116170900OtherMDCD PIN
MTH36117Medicare UPIN
MT000085379Medicare ID - Type Unspecified
MT000081945Medicare ID - Type Unspecified