Healthcare Provider Details

I. General information

NPI: 1033116405
Provider Name (Legal Business Name): ALAN B KRAVITZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 W. 24TH STREET STE C
YUMA AZ
85364-6298
US

IV. Provider business mailing address

1881 W. 24TH STREET STE C
YUMA AZ
85364-6298
US

V. Phone/Fax

Practice location:
  • Phone: 928-314-3333
  • Fax: 928-314-4333
Mailing address:
  • Phone: 928-314-3333
  • Fax: 928-314-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAZ0452
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: