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General NPI Number Information
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NPI Number | 1811308455
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Entity Type | Individual
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Provider Name | RYAN BRADBURY CRAIG M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 1415 TULANE AVE FL 2
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City | NEW ORLEANS
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State | LA
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Zip | 70112
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Country | US
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Telephone | 504-988-5224
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Fax | 504-988-7389
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Provider Business Mailing Address
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Address Line | 1430 TULANE AVE # 8679
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2632
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Country | US
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Telephone | 504-988-2419
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Fax | 504-988-2420
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 321262
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License Number State | LA
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