Provider Demographics
NPI:1154465300
Name:MORTON, CRAIG G (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:G
Last Name:MORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:LAKE CHARLES
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:1747 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-721-7236
Practice Address - Fax:337-721-7295
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200691208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K557D847OtherMEDICARE LEGACY NUMBER
LA1059609Medicaid
LAP00459654OtherRAILROAD MEDICARE INDIVIDUAL
LAP00776311Medicare PIN
LA1059609Medicaid
4K5577460Medicare PIN