Individual
DR. JAY OLIVER CRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5017
(601) 984-5042
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5017
(601) 984-5042
Taxonomy
Speciality
Code
Description
License number
State
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
22524
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01274279
—
MS
05
—
2406647
—
LA
Enumeration date
07/01/2010
Last updated
10/08/2018
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