Jeffrey Malcolm Kraut, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

G21238 Issued in CA

Practice address

510 Cypress St Ste D
Fort Bragg, CA 95437-5411

Phone

(707) 964-5696

Fax

(707) 964-6274

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285657189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST STE D",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-964-5696",
            "fax_number": "707-964-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST STE D",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-964-5696",
            "fax_number": "707-964-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAUT",
        "first_name": "JEFFREY",
        "middle_name": "MALCOLM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "G21238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG212380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Kirkman, MD
• Susan Jean Klarquist, FNP
• Lynette Kline, O.D.
• Pamela R Koehler, PA
• Peter Komu
• Jennifer Beth Kreger, MD
• Clifford Kuhn-Lloyd, AMFT
• Hsin Chieh Kuo, PHARMD
• Patricia Barbara Ladue, LCSW
• Nathaniel Gandy Lane, PA-C

• Pediatric Adolescent Medicine Physician in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.