Healthcare Provider Details

I. General information

NPI: 1326079617
Provider Name (Legal Business Name): RANDALL O CRAFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5416
US

IV. Provider business mailing address

4630 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5416
US

V. Phone/Fax

Practice location:
  • Phone: 602-584-8883
  • Fax: 602-899-4161
Mailing address:
  • Phone: 602-584-8883
  • Fax: 602-899-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number33325
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33325
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number33325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: