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General NPI Number Information
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NPI Number | 1629224225
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Entity Type | Individual
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Provider Name | CRAIG RUSSELL AINSWORTH MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-2460
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Fax |
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Provider Business Mailing Address
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Address Line | BAMC-3551 ROGER BROOKE DRIVE, MCHE-QD (CREDS)
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234
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Country | US
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Telephone | 210-916-2460
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Fax |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | Q5137
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 061688
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License Number State | GA
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