Provider Demographics
NPI:1093562126
Name:KRAUSS, JASON T
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:KRAUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4727
Mailing Address - Country:US
Mailing Address - Phone:520-339-6674
Mailing Address - Fax:
Practice Address - Street 1:2272 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4727
Practice Address - Country:US
Practice Address - Phone:520-339-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty