Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 33325 | AZ |
N | 208600000X | Surgeon | 33325 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 33325 | AZ |
NPI | 1326079617 |
---|---|
Provider Name | Dr. Randall O Craft |
First Address | Phoenix, AZ 85015-2143 |
Second Address | Phoenix, AZ 85015-2143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 16/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
896607 | (05) | AZ |
I21821 | (02) |