Healthcare Provider Details

I. General information

NPI: 1558355578
Provider Name (Legal Business Name): BRUCE L CRAIG MD FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 PATTERSON ST
POLLOCK LA
71467
US

IV. Provider business mailing address

124 RED OAK LOOP
POLLOCK LA
71467-4341
US

V. Phone/Fax

Practice location:
  • Phone: 318-765-3750
  • Fax:
Mailing address:
  • Phone: 318-765-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013065
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: