Provider Demographics
NPI:1689851420
Name:MARK LEE CRAFT MD PA
Entity Type:Organization
Organization Name:MARK LEE CRAFT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-4444
Mailing Address - Street 1:426 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 1:426 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH91885Medicare UPIN
K4607Medicare PIN
FLP00099252Medicare PIN
FL81278ZMedicare PIN