Provider Demographics
NPI:1326429689
Name:KROH, EVAN (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:KROH
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 1:1414 S 324TH ST STE B207
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8444
Mailing Address - Country:US
Mailing Address - Phone:253-220-3121
Mailing Address - Fax:260-422-4326
Practice Address - Street 1:1414 S 324TH ST STE B207
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8444
Practice Address - Country:US
Practice Address - Phone:253-220-3121
Practice Address - Fax:844-621-8051
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078735A207Q00000X
WAMD60845657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine