Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 1656 | SC |
N | 208D00000X | General Practice Physician | DO 5101018562 | MI |
NPI | 1356597330 |
---|---|
Provider Name | Ryan Thomas Krafft |
First Address | Mountain Home, AR 72653-2918 |
Second Address | Mountain Home, AR 72653-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2008 |
Last Update Date | 22/08/2016 |