Provider Demographics
NPI:1033277926
Name:KRUGER, RAYFORD S JR (MD)
Entity Type:Individual
Prefix:
First Name:RAYFORD
Middle Name:S
Last Name:KRUGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:3RD FL
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1138
Practice Address - Country:US
Practice Address - Phone:508-273-4900
Practice Address - Fax:508-273-4901
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110048469AMedicaid
MA110048469AMedicaid
MA1700387OtherUNITED
MAM20518Medicare PIN
MA8390OtherHP
MAE65546Medicare UPIN
MAJ09681OtherHMOB
MAM15141Medicare ID - Type Unspecified
MAJ0968102Medicare PIN
MA000000022228OtherBHN