Healthcare Provider Details

I. General information

NPI: 1366600058
Provider Name (Legal Business Name): DANIEL JAY KRAVITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER BLVD
LUFKIN TX
75904
US

IV. Provider business mailing address

2 MEDICAL CENTER BLVD
LUFKIN TX
75904-3173
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-8434
  • Fax:
Mailing address:
  • Phone: 936-634-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number104518
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number52275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: