Healthcare Provider Details

I. General information

NPI: 1700046422
Provider Name (Legal Business Name): RANDALL G. CRAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S HILLSIDE ST
WICHITA KS
67211-4001
US

IV. Provider business mailing address

3800 YORK ST
DENVER CO
80205-3540
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-2095
  • Fax: 316-330-3900
Mailing address:
  • Phone: 720-833-5014
  • Fax: 720-833-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30917
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG9084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: