Provider Demographics
NPI:1598924854
Name:DUCRUET, ANDREW FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:FREDERICK
Last Name:DUCRUET
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 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3964
Mailing Address - Fax:602-406-7131
Practice Address - Street 1:2910 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:602-406-3964
Practice Address - Fax:602-406-7131
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44138207T00000X, 207T00000X
NY240795-1207T00000X
PAMD448359207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ783617Medicaid
AZZ188729Medicare PIN