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General NPI Number Information
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NPI Number | 1457309098
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Entity Type | Individual
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Provider Name | LUCIUS CRAIG III M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 2600 BELLE CHASSE HWY SUITE I
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City | TERRYTOWN
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State | LA
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Zip | 70056-7156
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Country | US
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Telephone | 504-391-7670
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Fax | 504-378-9437
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Provider Business Mailing Address
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Address Line | PO BOX 1245
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City | ORANGEBURG
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State | SC
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Zip | 29116-1245
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Country | US
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Telephone | 803-395-4497
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Fax | 803-395-2237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | MD 024907
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 28692
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 28692
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License Number State | SC
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