Healthcare Provider Details

I. General information

NPI: 1205820164
Provider Name (Legal Business Name): DANIEL E KRUGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W SAINT MARYS RD
TUCSON AZ
85745-2623
US

IV. Provider business mailing address

5635 E HOLMES ST
TUCSON AZ
85711-2447
US

V. Phone/Fax

Practice location:
  • Phone: 520-872-4301
  • Fax: 520-872-6279
Mailing address:
  • Phone: 520-323-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number3667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: