Individual
MARK MALOY KRAUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8825
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8825
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1321
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061CM
BCBS OF TEXAS
TX
05
—
092733701
—
TX
Enumeration date
03/23/2006
Last updated
05/31/2019
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