Provider Demographics
NPI:1497736573
Name:KRUIDENIER, JAMES F (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:KRUIDENIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 LILLY RD NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5195
Mailing Address - Country:US
Mailing Address - Phone:360-413-8191
Mailing Address - Fax:360-413-8110
Practice Address - Street 1:500 LILLY RD NE
Practice Address - Street 2:SUITE 204
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5195
Practice Address - Country:US
Practice Address - Phone:360-413-8191
Practice Address - Fax:360-413-8110
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019766207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00019766OtherMD LISENCE
WAMD00019766OtherMD LISENCE
WAA08488Medicare UPIN