Provider Demographics
NPI:1235282302
Name:KRUEGER, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:KRUEGER
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 1:1006 S 64TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2090
Mailing Address - Country:US
Mailing Address - Phone:509-902-3625
Mailing Address - Fax:
Practice Address - Street 1:1006 S 64TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2090
Practice Address - Country:US
Practice Address - Phone:509-902-3625
Practice Address - Fax:509-676-3415
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00023988207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8309957Medicaid
WAE36896Medicare UPIN
WA8309957Medicaid