Healthcare Provider Details

I. General information

NPI: 1316573322
Provider Name (Legal Business Name): CRAIG E. KRCAL JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ROWLAND WAY STE 207
NOVATO CA
94945-5055
US

IV. Provider business mailing address

165 ROWLAND WAY STE 207
NOVATO CA
94945-5055
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-2680
  • Fax:
Mailing address:
  • Phone: 914-152-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-001086
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6075
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: