Provider Demographics
NPI:1457307977
Name:KRUGER, KRISTINE A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-941-3033
Mailing Address - Fax:503-747-7013
Practice Address - Street 1:10330 SE 32ND AVE STE 325
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-6656
Practice Address - Country:US
Practice Address - Phone:503-416-1960
Practice Address - Fax:503-416-1959
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500621625Medicaid