Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN11408 | FL |
Y | 213EG0000X | General Practice | DN11408 | FL |
NPI | 1003832718 |
---|---|
Provider Name | Dr. Mark Phillip Kraver |
First Address | Cape Coral, FL 33904-7208 |
Second Address | Cape Coral, FL 33904-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |