Provider Demographics
NPI:1417397001
Name:KRAKKER, JOSEPH JAMES III (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:KRAKKER
Suffix:III
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 1:203 S DAISY ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4709
Mailing Address - Country:US
Mailing Address - Phone:208-756-5600
Mailing Address - Fax:888-789-1866
Practice Address - Street 1:203 S DAISY ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4709
Practice Address - Country:US
Practice Address - Phone:208-756-6212
Practice Address - Fax:888-789-1866
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7858207Q00000X
IDO-0946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine