Healthcare Provider Details

I. General information

NPI: 1629365572
Provider Name (Legal Business Name): JOEL JASON KRAFT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6610
  • Fax:
Mailing address:
  • Phone: 918-786-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28499
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200382580A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 2
Identifier200468380R
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerGROUP MEDICAID
# 3
Identifier900522214
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerGROUP MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: