Healthcare Provider Details

I. General information

NPI: 1497703276
Provider Name (Legal Business Name): ROBERT B. CRAVENS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

PO BOX 245074 1501 N CAMPBELL AVE SUITE 5401
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2000
  • Fax:
Mailing address:
  • Phone: 520-626-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20145
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: