Provider Demographics
NPI:1821107004
Name:B ROBERT CRAGO PHD PC
Entity Type:Organization
Organization Name:B ROBERT CRAGO PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-323-0062
Mailing Address - Street 1:5363 E PIMA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3663
Mailing Address - Country:US
Mailing Address - Phone:520-323-0062
Mailing Address - Fax:520-323-1336
Practice Address - Street 1:5363 E PIMA ST
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3663
Practice Address - Country:US
Practice Address - Phone:520-323-0062
Practice Address - Fax:520-323-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0866103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0132730OtherBLUECROSS BLUESHIELD
AZ930653OtherAHCCCS
523104Medicare UPIN