Provider Demographics
NPI:1861840274
Name:CRAFTON, JORDAN W (DPM)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:W
Last Name:CRAFTON
Suffix:
Gender:M
Credentials:DPM
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 13627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-3627
Mailing Address - Country:US
Mailing Address - Phone:520-881-2600
Mailing Address - Fax:520-881-2844
Practice Address - Street 1:630 N ALVERNON WAY STE 351
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1838
Practice Address - Country:US
Practice Address - Phone:520-881-2600
Practice Address - Fax:520-881-2600
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 390200000X
AZPOD-000970213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program