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General NPI Number Information
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NPI Number | 1235305632
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Entity Type | Individual
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Provider Name | PAUL NICHOLAS DUCKRO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 2101 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-2845
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Country | US
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Telephone | 520-349-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 7140 E RIVER CANYON PL
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City | TUCSON
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State | AZ
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Zip | 85750-2109
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Country | US
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Telephone | 520-349-0615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3514
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License Number State | AZ
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