Healthcare Provider Details

I. General information

NPI: 1942282520
Provider Name (Legal Business Name): CRAIG D WHITING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W WALLACE ST
SAN SABA TX
76877-3928
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-2628
US

V. Phone/Fax

Practice location:
  • Phone: 325-372-5773
  • Fax: 325-372-3988
Mailing address:
  • Phone: 254-215-9704
  • Fax: 325-248-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF4681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: