Healthcare Provider Details

I. General information

NPI: 1366857245
Provider Name (Legal Business Name): PAUL R. KRAFFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N CLYDE MORRIS BLVD STE 550
DAYTONA BEACH FL
32114-2766
US

IV. Provider business mailing address

PO BOX 100265
GAINESVILLE FL
32610-0265
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-2340
  • Fax: 352-392-8413
Mailing address:
  • Phone: 352-273-9000
  • Fax: 352-392-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2014-0557
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number75220
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025035691
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME154623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: