Provider Demographics
NPI:1316025778
Name:CRAFT, PHILLIP ROY (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ROY
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:R
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD LLC
Mailing Address - Street 1:777 ARTHUR GODFREY RD.
Mailing Address - Street 2:SUITE #301
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-535-3550
Mailing Address - Fax:786-221-4435
Practice Address - Street 1:777 ARTHUR GODFREY RD.
Practice Address - Street 2:SUITE #301
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-535-3550
Practice Address - Fax:786-221-4435
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84264208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39465Medicare UPIN
51401Medicare ID - Type Unspecified