Healthcare Provider Details

I. General information

NPI: 1003476292
Provider Name (Legal Business Name): B. ROBERT CRAGO PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 E PIMA ST STE 100
TUCSON AZ
85712-3663
US

IV. Provider business mailing address

5363 E PIMA ST STE 100
TUCSON AZ
85712-3663
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-0062
  • Fax: 520-323-1336
Mailing address:
  • Phone: 520-323-0062
  • Fax: 520-323-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BYRL ROBERT CRAGO
Title or Position: PRESIDENT
Credential: PHD
Phone: 520-323-0062