Provider Demographics
NPI:1255401725
Name:STRUBLE, KRISTIN A (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:STRUBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4350 E CAMELBACK ROAD
Mailing Address - Street 2:SUITE G100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2720
Mailing Address - Country:US
Mailing Address - Phone:602-840-3120
Mailing Address - Fax:602-840-3237
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:SUITE G-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-840-3120
Practice Address - Fax:602-840-3237
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28982208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I11176Medicare UPIN
82394Medicare ID - Type Unspecified