Provider Demographics
NPI:1164502324
Name:KRAFT, JEFFREY G (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:KRAFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-265-2211
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:30 13TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5222
Practice Address - Country:US
Practice Address - Phone:406-265-2211
Practice Address - Fax:406-265-1651
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5B86207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241533744Medicaid
P00351359OtherRR MEDICARE
P00351359OtherRR MEDICARE
MO241533744Medicaid
MT058050115Medicare PIN