Provider Demographics
NPI:1639142417
Name:KRUGER, DAVID H
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:KRUGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:H
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 173894
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3894
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1100 BALSAM AVE.
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3404
Practice Address - Country:US
Practice Address - Phone:303-440-2037
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32503207P00000X
CODR.0032503207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200400320AMedicaid
WY122689400Medicaid
CO01325034Medicaid
UTZ5072Medicaid
AZ452417Medicaid
COP01131261OtherRAILROAD MEDICARE
KS200400320AMedicaid
COCOA106569Medicare PIN
COC803428Medicare PIN
COP01131261OtherRAILROAD MEDICARE