Individual
CRAIG T DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1467
(618) 549-0721
(618) 529-0479
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-107008
IL
208M00000X
Hospitalist Physician
Primary
036-107008
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5910517
—
NC
01
—
P00354534
RAILROAD MEDICARE
—
Enumeration date
10/19/2006
Last updated
06/01/2021
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