Provider Demographics
NPI:1376674390
Name:KRUEGER, PHILIP JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
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 1:901 CAMPUS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-991-9400
Mailing Address - Fax:650-991-2650
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-991-9400
Practice Address - Fax:650-991-2650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807797600Medicaid
AKMD5132WMedicaid
WA8485617Medicaid
CABR077ZMedicare PIN
AKMD5132WMedicaid
CABX010AMedicare PIN