Provider Demographics
NPI:1366465858
Name:KRUEGER, KURTIS RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:RAY
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CITIZENS PLZ
Mailing Address - Street 2:STE 300
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5754
Mailing Address - Country:US
Mailing Address - Phone:361-573-0756
Mailing Address - Fax:361-573-0633
Practice Address - Street 1:2700 CITIZENS PLZ
Practice Address - Street 2:STE 300
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5754
Practice Address - Country:US
Practice Address - Phone:361-573-0756
Practice Address - Fax:361-573-0633
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9698207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXP00469038Medicare PIN
TXC18059Medicare UPIN
TXPENDINGMedicaid