Provider Demographics
NPI:1902821234
Name:KRAFT, DEBRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 320TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5254
Mailing Address - Country:US
Mailing Address - Phone:253-946-5900
Mailing Address - Fax:253-946-6066
Practice Address - Street 1:720 S 320TH ST STE E
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5254
Practice Address - Country:US
Practice Address - Phone:253-946-5900
Practice Address - Fax:253-946-6066
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7132178Medicaid
WAG70318Medicare UPIN
WA7132178Medicaid