Provider Demographics
NPI:1568431120
Name:KRIEG, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:KRIEG
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 1:29826 HAUN ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MANIFEE SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586
Mailing Address - Country:US
Mailing Address - Phone:951-672-1911
Mailing Address - Fax:951-672-8406
Practice Address - Street 1:29826 HAUN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6546
Practice Address - Country:US
Practice Address - Phone:951-672-1911
Practice Address - Fax:951-672-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G424270Medicaid
CAA48959Medicare UPIN
CA00G424270Medicaid