Provider Demographics
NPI:1336321363
Name:KRUEGER, DENNIS ROY JR (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ROY
Last Name:KRUEGER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N CAMP ST.
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-379-8811
Mailing Address - Fax:830-379-2325
Practice Address - Street 1:14114 US HIGHWAY 87 W
Practice Address - Street 2:SUITE 2
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121
Practice Address - Country:US
Practice Address - Phone:830-779-4100
Practice Address - Fax:830-379-2325
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
321338YLWYMedicare PIN
TX8L11394Medicare PIN