Provider Demographics
NPI:1093758617
Name:KRONEN, FREDERICK L (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:L
Last Name:KRONEN
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-576-4040
Mailing Address - Fax:415-369-1240
Practice Address - Street 1:3883 AIRWAY DR STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1678
Practice Address - Country:US
Practice Address - Phone:707-521-4495
Practice Address - Fax:707-573-5421
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51036207P00000X
AZ21693207P00000X, 207Q00000X
CA212194261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G510340Medicaid
AZ419681Medicaid
CA00G510343Medicare PIN
A51878Medicare UPIN
AZ419681Medicaid
CA00G510340Medicaid