Provider Demographics
NPI:1669477790
Name:KRULL, HENRY G (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:KRULL
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 1:291 N FIREWEED ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7540
Mailing Address - Country:US
Mailing Address - Phone:907-262-6454
Mailing Address - Fax:907-262-0834
Practice Address - Street 1:289 N FIREWEED ST STE D
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7570
Practice Address - Country:US
Practice Address - Phone:907-262-6454
Practice Address - Fax:907-262-0832
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 4333Medicaid
AK200039684OtherALASKA RAILROAD I.D.
AKMD 4333Medicaid
AK150943Medicare ID - Type Unspecified
AKMD 4333Medicaid