Healthcare Provider Details

I. General information

NPI: 1568409944
Provider Name (Legal Business Name): CRAIG B. DANSHAW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OAKBEND TRL STE 230
FORT WORTH TX
76132
US

IV. Provider business mailing address

4100 INTERNATIONAL PLZ STE 600
FORT WORTH TX
76109-4823
US

V. Phone/Fax

Practice location:
  • Phone: 817-370-4721
  • Fax: 817-370-4941
Mailing address:
  • Phone: 817-529-2658
  • Fax: 817-334-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberJ1223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: