Provider Demographics
NPI:1689657926
Name:CRAFT, MARK LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:428 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5002
Mailing Address - Country:US
Mailing Address - Phone:813-681-4444
Mailing Address - Fax:813-661-8763
Practice Address - Street 1:428 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5002
Practice Address - Country:US
Practice Address - Phone:813-681-4444
Practice Address - Fax:813-661-8763
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH91885Medicare UPIN
FL81278ZMedicare PIN
FLP00099252Medicare PIN
K4607Medicare PIN