Provider Demographics
NPI:1558383828
Name:KRUG, RICHARD TANG (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TANG
Last Name:KRUG
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 1:3610 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5025
Mailing Address - Country:US
Mailing Address - Phone:360-493-5252
Mailing Address - Fax:360-493-5257
Practice Address - Street 1:3610 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5025
Practice Address - Country:US
Practice Address - Phone:360-493-5252
Practice Address - Fax:360-493-5257
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000381722086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery