Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | AZ0452 | AZ |
NPI | 1033116405 |
---|---|
Provider Name | Dr. Alan B Kravitz |
First Address | Yuma, AZ 85364-6298 |
Second Address | Yuma, AZ 85364-6298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
430611 | (05) | AZ |
AZ0194350 | BLUE CROSS/BLUE SHIELD AZ (01) | AZ |
U61882 | (02) | AZ |