Provider Demographics
NPI:1871666578
Name:KRUEGER, MARCY (MD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
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:PO BOX 6033
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-0181
Mailing Address - Country:US
Mailing Address - Phone:928-523-2131
Mailing Address - Fax:928-523-4411
Practice Address - Street 1:824 S. SAN FRANCISCO ST.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-523-2131
Practice Address - Fax:928-523-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine