Provider Demographics
NPI:1043278815
Name:KNETEN, CRAIG CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHARLES
Last Name:KNETEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8517
Mailing Address - Country:US
Mailing Address - Phone:817-921-6166
Mailing Address - Fax:817-921-9594
Practice Address - Street 1:1650 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4009
Practice Address - Country:US
Practice Address - Phone:817-922-7800
Practice Address - Fax:817-922-7801
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0924326-03Medicaid
TXG85487Medicare UPIN
TX8706B4Medicare ID - Type Unspecified