Provider Demographics
NPI:1205818978
Name:KREGER, RON M (MD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:M
Last Name:KREGER
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 1:419 FAIRVIEW AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1923
Mailing Address - Country:US
Mailing Address - Phone:580-762-8944
Mailing Address - Fax:580-762-9692
Practice Address - Street 1:419 FAIRVIEW AVE
Practice Address - Street 2:STE. 1
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1923
Practice Address - Country:US
Practice Address - Phone:580-762-8944
Practice Address - Fax:580-762-9692
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC95163Medicare UPIN