Healthcare Provider Details

I. General information

NPI: 1528261955
Provider Name (Legal Business Name): JOEL R.L. EHRENKRANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N FERGUSON AVE STE 104
TUCSON AZ
85712-2837
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-1010
  • Fax: 520-324-0029
Mailing address:
  • Phone: 520-324-7802
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number30639
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: