Provider Demographics
NPI:1689887358
Name:KRAKOVITZ, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:KRAKOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:KRAKOVITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:94 ELK RANGE DR
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS
Mailing Address - State:CO
Mailing Address - Zip Code:81654-9303
Mailing Address - Country:US
Mailing Address - Phone:970-927-4394
Mailing Address - Fax:970-927-4394
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1767
Practice Address - Country:US
Practice Address - Phone:970-920-4413
Practice Address - Fax:970-927-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO249522083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine