Provider Demographics
NPI:1497936231
Name:CRAFT, JEFFREY MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 OLDE CABIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7128
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-569-1787
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE T1275
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-6844
Practice Address - Fax:314-251-4337
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120032322085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1497936231Medicaid
MO1497936231Medicaid
MO102880012Medicare PIN