MEDICARE: CRAIG ALAN WARDELL 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	207Q00000X	Family Medicine Physician	ME75915	FL

General Provider Information

NPI Number	:	1851371686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALAN WARDELL M.D.

Provider Business Mailing Address
First Line	:	7924 E SHIMMERING WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-1272
Country	:	US
Telephone Number	:	520-733-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S ALAMO AVE
Second Line	:
City	:	DAVIS MONTHAN A F B
State	:	AZ
Zip	:	85707-6097
Country	:	US
Telephone Number	:	520-228-1593
Fax Number	:	520-228-8763

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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