MEDICARE: CRAIG PHELPS MD PC

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	207Q00000X	Family Medicine Physician	11010	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF1591	OTHER	OK	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1518187004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG PHELPS MD PC

Provider Business Mailing Address
First Line	:	PO BOX 1047
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73648-1047
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8603

Provider Business Practice Location Address
First Line	:	1710 W 3RD ST
Second Line	:	SUITE 103B
City	:	ELK CITY
State	:	OK
Zip	:	73644-5159
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8603

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	CRAIG PHELPS
Credential	:	MD
Telephone Number	:	580-225-8600

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/24/2007

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Directions to “CRAIG PHELPS MD PC ” Practice Location

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