Provider Demographics
NPI:1144213190
Name:KRAKOWER, JEFFERY MARC (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:MARC
Last Name:KRAKOWER
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 1:5505 SUR MER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7654
Mailing Address - Country:US
Mailing Address - Phone:650-248-1159
Mailing Address - Fax:916-932-4289
Practice Address - Street 1:5505 SUR MER DRIVE
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7654
Practice Address - Country:US
Practice Address - Phone:650-248-1159
Practice Address - Fax:916-932-4289
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30387207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G303870OtherBLUE CROSS
00G303870OtherTRICARE
00G303870OtherPACIFICARE
00G303870OtherBLUE SHIELD
A89493Medicare UPIN
00G303870OtherTRICARE