Provider Demographics
NPI:1285657189
Name:KRAUT, JEFFREY MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MALCOLM
Last Name:KRAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CYPRESS ST STE D
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5411
Mailing Address - Country:US
Mailing Address - Phone:707-964-5696
Mailing Address - Fax:707-964-6274
Practice Address - Street 1:510 CYPRESS ST STE D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5411
Practice Address - Country:US
Practice Address - Phone:707-964-5696
Practice Address - Fax:707-964-6274
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG212382080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG212380Medicaid
CAA41214Medicare UPIN
CA553843Medicare ID - Type Unspecified