Healthcare Provider Details

I. General information

NPI: 1588619704
Provider Name (Legal Business Name): JEFFREY C CRAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SHERRY AVENUE
PARK FALLS WI
55552
US

IV. Provider business mailing address

98 SHERRY AVENUE
PARK FALLS WI
55552
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2484
  • Fax: 715-762-7503
Mailing address:
  • Phone: 715-762-2484
  • Fax: 715-762-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39840
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39840
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: