Provider Demographics
NPI:1649270539
Name:CRAYTOR, BRET F (MD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:F
Last Name:CRAYTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5600
Mailing Address - Fax:615-373-5280
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5220
Practice Address - Country:US
Practice Address - Phone:903-614-5111
Practice Address - Fax:903-614-5114
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8974207RP1001X
ARE0731207RP1001X
OK16975207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130592001Medicaid
OK10090430CMedicaid
TX100706402Medicaid
00X032Medicare PIN
OK10090430CMedicaid
TX8032M0Medicare ID - Type Unspecified