Provider Demographics
NPI:1003476292
Name:B. ROBERT CRAGO PHD PC
Entity Type:Organization
Organization Name:B. ROBERT CRAGO PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-323-0062
Mailing Address - Street 1:5363 E PIMA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3663
Mailing Address - Country:US
Mailing Address - Phone:520-323-0062
Mailing Address - Fax:520-323-1336
Practice Address - Street 1:5363 E PIMA ST STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3663
Practice Address - Country:US
Practice Address - Phone:520-323-0062
Practice Address - Fax:520-323-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty