Provider Demographics
NPI:1932189818
Name:CRAIG, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
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 1:607 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6337
Mailing Address - Country:US
Mailing Address - Phone:662-377-6290
Mailing Address - Fax:662-377-6295
Practice Address - Street 1:2147 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6405
Practice Address - Country:US
Practice Address - Phone:662-377-6290
Practice Address - Fax:662-377-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12830208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112173Medicaid
MSP00312002Medicare PIN
MS240000097Medicare ID - Type Unspecified
MS00112173Medicaid