Omohundro, Craig Dean
Omohundro, Craig Dean is an individual health care provider with primary practice located at 4300 W Main St Suite 102, Dothan AL 36305-1054. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Omohundro, Craig Dean can be contacted via phone (334) 793-9564.Contact Information
Primary practice address
4300 W Main St Suite 102
Dothan AL 36305-1054
Phone: (334) 793-9564
Fax: (334) 671-8907
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 20605 | Alabama |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 20605 | Alabama |
Profile Details
| NPI number | 1457346850 |
|---|---|
| LBN Legal business name | Omohundro, Craig Dean |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2005 |
| Last updated | Oct 22nd, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457346850 | NPPES |
| Florida | MEDICAID | 255070900 | |
| Florida | MEDICAID | 00749185A | |
| Florida | MEDICAID | 000032376 |
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