Provider Demographics
NPI:1639172422
Name:KUGLEN, CRAIG C JR (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:C
Last Name:KUGLEN
Suffix:JR
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 1:400 S LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3302
Mailing Address - Country:US
Mailing Address - Phone:936-539-4500
Mailing Address - Fax:936-539-1216
Practice Address - Street 1:400 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3302
Practice Address - Country:US
Practice Address - Phone:936-539-4500
Practice Address - Fax:936-539-1216
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9530207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1246639-01Medicaid
TX1246639-01Medicaid
TXF02304Medicare UPIN
TX85901NMedicare ID - Type UnspecifiedMEDICARE