Provider Demographics
NPI:1508219569
Name:FREDERICK J KRUGER DPM INC
Entity Type:Organization
Organization Name:FREDERICK J KRUGER DPM INC
Other - Org Name:FREDERICK J KRUGER DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-447-9040
Mailing Address - Street 1:530 E HERNDON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2990
Mailing Address - Country:US
Mailing Address - Phone:559-447-9040
Mailing Address - Fax:
Practice Address - Street 1:530 E HERNDON AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2990
Practice Address - Country:US
Practice Address - Phone:559-447-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27820Medicare PIN