MEDICARE: CRAIG WARNER DUFF

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1538669262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG WARNER DUFF

Provider Business Mailing Address
First Line	:	207 N HWY 59
Second Line	:
City	:	KANSAS
State	:	OK
Zip	:	74347-0000
Country	:	US
Telephone Number	:	918-786-4434
Fax Number	:	918-786-4435

Provider Business Practice Location Address
First Line	:	207 N HWY 59
Second Line	:
City	:	KANSAS
State	:	OK
Zip	:	74347-0000
Country	:	US
Telephone Number	:	918-786-4434
Fax Number	:	918-786-4435

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	04/03/2018

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Directions to “ CRAIG WARNER DUFF ” Practice Location

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