Provider Demographics
NPI:1710977079
Name:KROUSE, DONALD E (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:KROUSE
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:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-623-1196
Practice Address - Street 1:560 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-0000
Practice Address - Country:US
Practice Address - Phone:530-623-3735
Practice Address - Fax:530-623-1196
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A426130Medicaid
CA00A426130Medicaid
CAA29612Medicare UPIN