Provider Demographics
NPI:1376573535
Name:CRAFT, PAUL EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:CRAFT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:604 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9515
Practice Address - Country:US
Practice Address - Phone:336-802-2015
Practice Address - Fax:336-802-2016
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970015100OtherRAILROAD MEDICARE
S87840Medicare UPIN
NC2752576AMedicare PIN
NC2752576Medicare PIN