Provider Demographics
NPI:1245344639
Name:KRYC, JOSEPH J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:KRYC
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 1:4002 E MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8612
Mailing Address - Country:US
Mailing Address - Phone:480-981-9151
Mailing Address - Fax:480-324-5459
Practice Address - Street 1:4002 E MAIN ST
Practice Address - Street 2:STE1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8612
Practice Address - Country:US
Practice Address - Phone:480-981-9151
Practice Address - Fax:480-324-5459
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19434207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ293192Medicaid
28523Medicare ID - Type Unspecified
AZZ128844Medicare PIN
AZ293192Medicaid