Provider Demographics
NPI:1144280249
Name:CRAIG, H RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:H RANDALL
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:RANDALL
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2155 E CONFERENCE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2604
Mailing Address - Country:US
Mailing Address - Phone:480-831-2445
Mailing Address - Fax:480-897-1283
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-831-2445
Practice Address - Fax:480-897-1283
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17760207V00000X, 208D00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104597Medicaid
E52286Medicare UPIN