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CRAIG DEAN OMOHUNDRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4300 W MAIN ST, SUITE 102, DOTHAN, AL 36305-1054
(334) 793-9564
(334) 671-8907
Mailing address
4300 W MAIN ST, SUITE 102, DOTHAN, AL 36305-1054
(334) 793-9564
(334) 671-8907

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20605
AL
207ND0101X
MOHS-Micrographic Surgery Physician
20605
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000032376
AL
05
00749185A
GA
05
255070900
FL
Enumeration date
09/13/2005
Last updated
10/22/2015
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