Provider Demographics
NPI:1003837402
Name:LAWRENCE G. KRUGMAN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE G. KRUGMAN, M.D., A MEDICAL CORPORATION
Other - Org Name:LAWRENCE G. KRUGMAN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-8626
Mailing Address - Street 1:14690 APPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5106
Mailing Address - Country:US
Mailing Address - Phone:760-242-8626
Mailing Address - Fax:760-242-0948
Practice Address - Street 1:1301 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3219
Practice Address - Country:US
Practice Address - Phone:760-256-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15250207Q00000X, 207R00000X, 207RE0101X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care