Provider Demographics
NPI:1265436711
Name:CRAIG, ROBERT DANIEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:STE 320E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8789
Mailing Address - Country:US
Mailing Address - Phone:314-567-4868
Mailing Address - Fax:314-567-7639
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:STE 320E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8789
Practice Address - Country:US
Practice Address - Phone:314-567-4868
Practice Address - Fax:314-567-7639
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9N78207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD34550Medicare UPIN