Provider Demographics
NPI:1851391411
Name:KRATZ, JAIME (MD)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:KRATZ
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 1:8202 WASHINGTON ST
Mailing Address - Street 2:PORT RICHEY
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6679
Mailing Address - Country:US
Mailing Address - Phone:727-819-1610
Mailing Address - Fax:727-868-0596
Practice Address - Street 1:8202 WASHINGTON ST
Practice Address - Street 2:PORT RICHEY
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6679
Practice Address - Country:US
Practice Address - Phone:727-819-1610
Practice Address - Fax:727-868-0596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0065284207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375168600Medicaid
FL375168600Medicaid
FL25092WMedicare PIN