Basic Information
| Provider Information | |||||||||
| NPI: | 1881199867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAVEN | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9149 1 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042932436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | MSC11 6025 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 81731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725062 | ||||||||
| FaxNumber: | 5052726503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 29828 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | MD2022-0755 | NM | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.