Provider Demographics
NPI:1225121791
Name:CRUCIGER, MARC P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:P
Last Name:CRUCIGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:711 VAN NESS AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3285
Mailing Address - Country:US
Mailing Address - Phone:415-668-2118
Mailing Address - Fax:415-668-3461
Practice Address - Street 1:711 VAN NESS AVE
Practice Address - Street 2:STE 310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3285
Practice Address - Country:US
Practice Address - Phone:415-668-2118
Practice Address - Fax:415-668-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG39873207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G398730Medicaid
CA00G398730Medicaid
00G398730Medicare ID - Type Unspecified