Basic Information
| Provider Information | |||||||||
| NPI: | 1366857245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAFFT | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100265 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522739000 | ||||||||
| FaxNumber: | 3523928413 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 N CLYDE MORRIS BLVD STE 550 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862552340 | ||||||||
| FaxNumber: | 3523928413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | RS2014-0557 | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207T00000X | ME154623 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.