1336321363 NPI number — DENNIS ROY KRUEGER JR. P.A.-C

Table of content: DENNIS ROY KRUEGER JR. P.A.-C (NPI 1336321363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336321363 NPI number — DENNIS ROY KRUEGER JR. P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUEGER
Provider First Name:
DENNIS
Provider Middle Name:
ROY
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.A.-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336321363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 N CAMP ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEGUIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-379-8811
Provider Business Mailing Address Fax Number:
830-379-2325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14114 US HIGHWAY 87 W
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LA VERNIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-779-4100
Provider Business Practice Location Address Fax Number:
830-379-2325
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA05457 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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