Provider Demographics
NPI:1689612293
Name:SIERRA VISTA INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:SIERRA VISTA INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-458-8145
Mailing Address - Street 1:75 COLONIA DE SALUD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-458-8145
Mailing Address - Fax:877-771-1056
Practice Address - Street 1:75 COLONIA DE SALUD
Practice Address - Street 2:SUITE 200A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-8145
Practice Address - Fax:877-771-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76714Medicare UPIN
AZ101898Medicare ID - Type Unspecified