Provider Demographics
NPI:1255422820
Name:BAMME, CRAIG H (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
Last Name:BAMME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4947
Mailing Address - Country:US
Mailing Address - Phone:727-209-2828
Mailing Address - Fax:727-209-2829
Practice Address - Street 1:5317 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4947
Practice Address - Country:US
Practice Address - Phone:727-209-2828
Practice Address - Fax:727-209-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS4073OtherFLORIDA LICENSE
FL57579AMedicare ID - Type Unspecified
FLA80592Medicare UPIN