Provider Demographics
NPI:1275561151
Name:REDDING DERMATOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:REDDING DERMATOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRAFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-1111
Mailing Address - Street 1:2107 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2433
Mailing Address - Country:US
Mailing Address - Phone:530-241-1111
Mailing Address - Fax:531-241-1483
Practice Address - Street 1:2107 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-241-1111
Practice Address - Fax:531-241-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06888ZMedicare PIN