Healthcare Provider Details

I. General information

NPI: 1801518477
Provider Name (Legal Business Name): MATTHEW LUTHER CRAIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax:
Mailing address:
  • Phone: 907-714-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number4934
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: