MEDICARE: CRAIG A NORDHUES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	102394	MO
2	208VP0000X	Pain Medicine Physician	102394	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51548349	OTHER	AL	BCBS OF AL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51548352	OTHER	AL	BCBS OF AL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	51548351	OTHER	AL	BCBS OF AL
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	51548354	OTHER	AL	BCBS OF AL
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376528414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A NORDHUES M.D.

Provider Business Mailing Address
First Line	:	1118 ROSS CLARK CIR
Second Line	:	SUITE 700
City	:	DOTHAN
State	:	AL
Zip	:	36301-3001
Country	:	US
Telephone Number	:	334-793-5105
Fax Number	:	334-671-5073

Provider Business Practice Location Address
First Line	:	1108 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-3022
Country	:	US
Telephone Number	:	334-793-5105
Fax Number	:	334-671-5073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/02/2008

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1164403861 — HOUSTON COUNTY HEALTHCARE AUTHORITY
Practice Location Address:

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Directions to “ CRAIG A NORDHUES M.D.” Practice Location

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