Provider Demographics
NPI:1578673497
Name:KRUFKY, EDWARD LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LINCOLN
Last Name:KRUFKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 E VALLEY VISTA LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5349
Mailing Address - Country:US
Mailing Address - Phone:480-315-0628
Mailing Address - Fax:
Practice Address - Street 1:6802 E VALLEY VISTA LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5349
Practice Address - Country:US
Practice Address - Phone:480-315-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ198422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB93377Medicare UPIN