Provider Demographics
NPI:1033270079
Name:KROACK, DEBRA ANN (MD(PC INCORPORAT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:KROACK
Suffix:
Gender:F
Credentials:MD(PC INCORPORAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5679 E. GRANT ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2211
Mailing Address - Country:US
Mailing Address - Phone:520-722-6003
Mailing Address - Fax:520-751-2736
Practice Address - Street 1:5679 E. GRANT ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2211
Practice Address - Country:US
Practice Address - Phone:520-722-6003
Practice Address - Fax:520-751-2736
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD17832Medicare ID - Type Unspecified
E39408Medicare UPIN
AZZMD17832Medicare UPIN
AZE-39408Medicare UPIN
AZZMD17832Medicare PIN