MEDICARE: CRAIG L DEARDEN 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
1	207R00000X	Internal Medicine Physician	F3894	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110247666	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962427773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG L DEARDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-332-6902

Provider Business Practice Location Address
First Line	:	1000 NINTH AVENUE
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3906
Country	:	US
Telephone Number	:	817-332-3039
Fax Number	:	817-332-6902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/30/2011

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Directions to “ CRAIG L DEARDEN MD” Practice Location

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