Provider Demographics
NPI:1336260025
Name:KROFT, JERRY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HOWARD
Last Name:KROFT
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 1:33 COZZOLINO DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1301
Mailing Address - Country:US
Mailing Address - Phone:650-583-9856
Mailing Address - Fax:650-583-1010
Practice Address - Street 1:45 CASTRO ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-861-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30062207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology