Provider Demographics
NPI:1033116405
Name:KRAVITZ, ALAN B (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:KRAVITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 W. 24TH STREET
Mailing Address - Street 2:STE C
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6298
Mailing Address - Country:US
Mailing Address - Phone:928-314-3333
Mailing Address - Fax:928-314-4333
Practice Address - Street 1:1881 W. 24TH STREET
Practice Address - Street 2:STE C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6298
Practice Address - Country:US
Practice Address - Phone:928-314-3333
Practice Address - Fax:928-314-4333
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0194350OtherBLUE CROSS/BLUE SHIELD AZ
AZ430611Medicaid
AZ430611Medicaid
AZ4381620001Medicare NSC
AZAZ0194350OtherBLUE CROSS/BLUE SHIELD AZ
AZZ68974Medicare PIN