Provider Demographics
NPI:1053396762
Name:CRAIG, PAUL MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARTIN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 E OVERBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3454
Mailing Address - Country:US
Mailing Address - Phone:509-535-3565
Mailing Address - Fax:
Practice Address - Street 1:12401 E SINTO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1081
Practice Address - Country:US
Practice Address - Phone:509-922-2055
Practice Address - Fax:509-922-2307
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030268207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7104243Medicaid
WAF02171Medicare UPIN
WAGAB18043Medicare ID - Type Unspecified