MEDICARE: DR. RANDALL O CRAFT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	33325	AZ
2	2086S0122X	Plastic and Reconstructive Surgery Physician	33325	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326079617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL O CRAFT M.D.

Provider Business Mailing Address
First Line	:	6036 N 19TH AVE STE 501
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2143
Country	:	US
Telephone Number	:	602-899-6444
Fax Number	:	602-899-4161

Provider Business Practice Location Address
First Line	:	6036 N 19TH AVE STE 501
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2143
Country	:	US
Telephone Number	:	602-899-6444
Fax Number	:	602-899-4161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/16/2020

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