Provider Demographics
NPI:1598143570
Name:KRASE, JEFFREY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:KRASE
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 1:1515 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245024
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5024
Mailing Address - Country:US
Mailing Address - Phone:520-626-6024
Mailing Address - Fax:520-626-6033
Practice Address - Street 1:1515 N CAMPBELL AVE
Practice Address - Street 2:UACC 1909
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5024
Practice Address - Country:US
Practice Address - Phone:520-626-6024
Practice Address - Fax:520-626-6033
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR75012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology