Provider Demographics
NPI:1861548117
Name:THAYER, CRAIG R (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:THAYER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-0202
Mailing Address - Country:US
Mailing Address - Phone:530-626-1103
Mailing Address - Fax:530-676-3628
Practice Address - Street 1:941 SPRING ST
Practice Address - Street 2:SUITEA
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4546
Practice Address - Country:US
Practice Address - Phone:530-626-1102
Practice Address - Fax:530-626-4337
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG62641208600000X, 2086S0102X, 2086S0127X, 2086S0129X, 2086X0206X, 208C00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)