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NPI Code Detail

MEDICARE: CRAIG E DITSCH MD

MEDICARE: CRAIG E DITSCH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianH3356TX
2207Q00000XFamily Medicine PhysicianC4928AR

General Provider Information

NPI Number : 1700886603
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG E DITSCH MD
Provider Business Mailing Address
First Line : 5002 COWHORN CREEK RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-9766
Country : US
Telephone Number : 903-614-3000
Fax Number : 903-614-3525
Provider Business Practice Location Address
First Line : 5002 COWHORN CREEK RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-9766
Country : US
Telephone Number : 903-614-3000
Fax Number : 903-614-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/08/2007

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Directions to “ CRAIG E DITSCH MD” Practice Location

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