Individual
MS. JOHNETTA CRAIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 HOLLY HILLS AVE, SAINT LOUIS, MO 63111-2410
(314) 481-1615
(314) 353-1310
Mailing address
401 HOLLY HILLS AVE, SAINT LOUIS, MO 63111-2410
(314) 481-1615
(314) 353-1310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
107456
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003010581
CPIN
MO
05
—
209702612
—
MO
05
—
209702620
—
MO
Enumeration date
11/30/2005
Last updated
07/01/2014
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