Healthcare Provider Details

I. General information

NPI: 1831149103
Provider Name (Legal Business Name): BRUCE W KRELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S DOBSON RD STE 203
CHANDLER AZ
85224-5680
US

IV. Provider business mailing address

725 S DOBSON RD STE 203
CHANDLER AZ
85224-5680
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-8532
  • Fax: 480-807-0420
Mailing address:
  • Phone: 480-807-8532
  • Fax: 480-807-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0316
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAZ00316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: