Provider Demographics
NPI:1346231388
Name:KRAUSE, ROBERT ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:KRAUSE
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 1:11 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7326
Mailing Address - Country:US
Mailing Address - Phone:910-353-9906
Mailing Address - Fax:910-353-4853
Practice Address - Street 1:11 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7326
Practice Address - Country:US
Practice Address - Phone:910-353-9906
Practice Address - Fax:910-353-4853
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950318Medicaid
NC50318OtherBCBS
D9805OtherMEDCOST
P00200893OtherRAILROAD MEDICARE
0128877OtherUNITED HEALTHCARE
561714815BOtherCIGNA
C84996Medicare UPIN
D9805OtherMEDCOST