Healthcare Provider Details

I. General information

NPI: 1710042585
Provider Name (Legal Business Name): CRAIG LEOPOLD ESCUDE M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HIGHWAY 468 WEST
WHITFIELD MS
39193-0157
US

IV. Provider business mailing address

PO BOX 157A
WHITFIELD MS
39193-0157
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-8000
  • Fax: 601-351-8301
Mailing address:
  • Phone: 601-351-8000
  • Fax: 601-351-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13577
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: