Individual
DR. CRAIG ALLEN KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1530 BIXBY RD, MOUNDS, OK 74047-5335
(918) 366-9152
(918) 366-1170
Mailing address
1530 BIXBY RD, MOUNDS, OK 74047-5335
(918) 366-9152
(918) 366-1170
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14981
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100790580D
—
OK
01
—
930085465
RAILROAD MEDICARE
OK
Enumeration date
11/04/2005
Last updated
03/23/2010
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