=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194217810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES DOUGLAS CRAIG III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13603 W HILLSBOROUGH AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33635-9653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-921-6040
-----------------------------------------------------
Fax | 813-921-6042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 PINEHURST DR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-3833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5305
-----------------------------------------------------
Fax | 352-616-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME146606
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------