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NPI Code Detail

MEDICARE: CRAIG S. THALACKER M.D.

MEDICARE: CRAIG S. THALACKER 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
1207P00000XEmergency Medicine PhysicianMD150996OR

General Provider Information

NPI Number : 1558361378
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG S. THALACKER M.D.
Provider Business Mailing Address
First Line : 1111 CRATER LAKE AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-6241
Country : US
Telephone Number : 514-732-6440
Fax Number :
Provider Business Practice Location Address
First Line : 1111 CRATER LAKE AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-6241
Country : US
Telephone Number : 514-732-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 01/15/2011

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Directions to “ CRAIG S. THALACKER M.D.” Practice Location

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