Provider Demographics
NPI:1174678130
Name:KRUG, THOMAS JOSEPH (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:KRUG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10358 SORENSTAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-6609
Mailing Address - Country:US
Mailing Address - Phone:916-682-0864
Mailing Address - Fax:916-973-6354
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:2ND FLOOR ANESTHESIA DEPARTMENT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-7696
Practice Address - Fax:916-973-6354
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ13898Medicare UPIN