Provider Demographics
NPI:1750337960
Name:SMITH, CRAIG M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 W WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4536
Mailing Address - Country:US
Mailing Address - Phone:361-758-2799
Mailing Address - Fax:361-758-2707
Practice Address - Street 1:1731 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-758-2799
Practice Address - Fax:361-758-2707
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133365008Medicaid
00654TMedicare ID - Type Unspecified
TXTXB110487Medicare PIN
TXB102377Medicare PIN
TX87N925Medicare ID - Type Unspecified
TX133365008Medicaid