Provider Demographics
NPI:1053403774
Name:CANFIELD, CRAIG WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WESLEY
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:225 PRADO RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7363
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:35 CASA ST STE 370
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5835
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64478208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644780Medicaid
CA00G644780Medicaid
CAF49464Medicare UPIN
CAWG64478AMedicare PIN