Provider Demographics
NPI:1689760506
Name:CRAFT, WILLIAM BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:CRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:940 ROYAL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6193
Practice Address - Country:US
Practice Address - Phone:541-732-8388
Practice Address - Fax:541-618-9089
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22870208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287611Medicaid
ORR132331Medicare PIN